First enacted in 1965, Title XIX of the Social Security Act established a federal funding program which remains critically important to America’s elderly population today: Medicaid. Title XIX, frequently referred to simply as Medicaid or the Medicaid Act, allows the federal government to furnish participating states with grants intended to provide medical care for low-income persons, as well as rehabilitation and education services designed to foster greater financial self-sufficiency. While participation in the Medicaid program is not compulsory, those states which do elect to accept federal funding are subsequently obligated to comply with the provisions contained within the Medicaid Act.
Prior to amendments made by Congress in 1987, the Medicaid and Medicare (Title XVIII) Acts arguably suffered from weak enforcement. Before 1987, these Acts provided few forms of penalization for noncompliance. If a nursing home was found to be in violation of either Act, the consequences were limited to revocation of the offending facility’s certification, termination of Medicaid reimbursements, and the imposition of a maximum 11-month period during which payment for new admissions could be denied. In turn, noncompliant facilities often faced little to no significant penalization for violations, which too often allowed for substandard care to continue unchecked.
Eventually, Congress raised concerns about lax Medicaid Act enforcement and the resulting climate of neglect and abuse. These concerns led to the aforementioned reforms of 1987, when Congress passed the Federal Nursing Home Reform Amendments (also known as the Federal Nursing Home Reform “Act”), contained in OBRA, to provide for the oversight and inspection of nursing homes that participate in Medicare and Medicaid programs. The requirements for certification include satisfying certain standards in areas such as “quality of care” and “resident rights.”
The plain language of the FNHRA shows that it was not intended to benefit health care providers, but rather it was intended to benefit nursing home residents. The statute contains a long list of rights to be afforded residents and commands certain state and nursing home activities in order to ensure that residents receive necessary services. In short, after clearly identifying those it seeks to protect, the statute goes on to endow them with particular rights and the standard of care they are owed by nursing home facilities.
Specifically, the FNHRA provides for:
In addition, FNHRA specifically set forth care standards owed to residents. Some of the most significant provisions provide that participating nursing homes and nursing facilities must:
Additionally, the FNHRA also reinforced the previous nursing home inspection guidelines. In accordance with the 1987 changes affected by the FNHRA, participating facilities are now subject to surprise surveys, during which medical records may be reviewed and residents may be interviewed. If a facility fails to pass a surprise assessment due to noncompliance with the Act, it may be subject to harsh penalties. While all states are subject to identical minimum inspection requirements, some states have also opted to impose their own additional set of standards, making their compliance standards even more rigorous. As a result of the FNHRA, today’s standards for nursing homes are far more stringent than they were just a few decades ago.
For more information, refer to the Federal Nursing Home Reform Amendments.
If you’re worried about the standard of care at your elderly loved one’s facility, call nursing home neglect attorney Brent Wieand at (215) 666-7777, or contact us online to set up a free and private case evaluation.