Federal and State Regulations

By: David K. Jaffe

Federal Regulations

In 1987, President Ronald Reagan signed into law the first major revision of the federal standards for nursing home care since the 1965 creation of both Medicare and Medicaid. This landmark legislation changed society’s legal expectations of nursing homes care. Long term care facilities desiring Medicare or Medicaid funding must provide services enabling residents to "attain and maintain their highest practicable physical, mental, and psychosocial well-being."

The Federal Nursing Home Reform Act or OBRA ‘87 created a minimum set of national standards of care and rights for people living in certified nursing facilities.

Federal OBRA regulations §483.20(k) Resident assessment specifies that "The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment."

Federal OBRA regulations §483.25 (c) (1) requires that "a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable...." §483.25 (c) (2) specifies that " a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing."

Federal OBRA regulations Section 483.20 (b) (1) (xii) requires a facility to make periodic comprehensive patient assessments [including skin condition].

Federal OBRA regulations §483.10 (b)(11)(B and C) requires that a facility immediately consult with the resident’s physician when there is a significant change in the resident’s physical status and/or a need to alter treatment significantly.

Federal OBRA regulations §483.75 (1) requires that nursing facilities maintain records on each resident in accordance with accepted professional standards and practice. F tag 514 provides guidance to surveyors in interpreting Federal OBRA regulations §483.75 (1), specifically requiring that clinical records are complete, accurately documented, easily accessible, and systematically organized. The CMS Interpretive Guidelines for F tag 514 direct state surveyors to ask the following question during the survey: "is there enough record documentation for staff to conduct care programs and revised the program, as necessary, to respond to changing status of the resident as a result of interventions?"