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Nursing Home Reform Act applies to all Nursing Homes Accepting Payment from Medicare or Medicaid

Nursing Home Reform Act applies to all Nursing Homes Accepting Payment from Medicare or Medicaid

Elderly woman and nurse in a skilled nurding facility. Image © Alexander RathsThe Nursing Homes Reform Law ( Section 483.1 et seq. Title 42 of the Code of Federal Regulations) applies to every Nursing Home that is certified to accept payment from the Medicare or Medicaid programs

even if the resident involved is not eligible for either program and as a result is paying privately. Because Medicare and Medicaid are important sources of payment, over 95 percent of nursing homes are governed by the Reform Law.
The Reform Law’s cornerstone is the requirement that each nursing home provide the care that a resident needs to reach his or her highest practicable level of functioning. (See Section 483.25 of Title 42 of the Code of Federal Regulations) Some residents are capable of gaining strength and function; other residents are capable of maintaining their current condition. Still other residents at most may be able to moderate their level of decline. In all of these situations, the nursing home must provide all necessary care.
Each state maintains an inspection agency (often part of the state’s Health Department) that is responsible for monitoring nursing homes’ compliance with the Reform Law, certifying nursing homes for participation in Medicare and Medicaid, and issuing state licenses. Each of these agencies will investigate in response to a consumer complaint, and can issue warnings or impose penalties to force a nursing home to fix a particular violation.

The National Consumer Voice for Quality Long-Term Care (www.theconsumervoice.org) has many helpful publications for nursing home residents and their families. The federal government maintains a Nursing Home Compare website (www.medicare.gov/nursinghomecompare/search.html) that provides extensive information on individual nursing homes.


The Peck Law Group

About the Author

Attorney Adam Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.

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