(8) Posting of survey results.—A nursing facility must post in a place readily accessible to residents, and family members and legal representatives of residents, the results of the most recent survey of the facility conducted under subsection (g). (d) Requirements Relating to Administration and Other Matters.— (1) Administration.— (A) In general.—A nursing facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each. (B) 184 Required notices.—If a change occurs in— (i) the persons with an ownership or control interest (as defined in section 1124(a 3) ) in the facility (ii) the persons who are officers, directors, agents, or managing employees (as defined in section 1126(b) ). (C) Nursing facility administrator.—The administrator of a nursing facility must meet standards established by the secretary under subsection (f 4). (V) availability of survey, certification, and complaint investigation reports.—A nursing facility must— (i) have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and (ii) post notice. The facility shall not make available under clause (i) identifying information about complainants or residents.
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(6) Protection of resident funds.— (A) In general.—The nursing facility— (i) may not require residents to deposit their personal funds with the facility, and (ii) upon the written authorization of the resident, must hold, safeguard, and account for such personal funds under a system established. (B) Management of personal funds.—Upon written authorization of a resident under subparagraph (a ii the facility must manage and account for the personal funds of the resident deposited with the facility as follows: (i) Deposit.—The facility must deposit any amount of personal funds in excess. With respect to any other personal funds, the facility must maintain such funds in a non-interest bearing account or petty cash fund. (ii) Accounting and records.—The facility must assure a full and complete separate accounting of each such residents personal funds, maintain a written record of all financial transactions involving the personal funds of a resident deposited with the facility, and afford the resident (or a legal. (iii) Notice of certain balances.—The facility must notify each resident receiving medical assistance under the State plan under title xix when the amount in the residents account reaches 200 less than the dollar amount determined under section 1611(a 3 B) and the fact that. (iv) Conveyance upon death.— Upon the death of a resident with such an account, the facility must convey promptly the residents personal funds (and a final accounting of such funds) to the individual administering the residents estate. (C) Assurance of financial security.—The facility must purchase a surety bond, or otherwise provide assurance satisfactory to the secretary, to assure the security of all personal funds of residents deposited with the facility. (D) Limitation on charges to personal funds.—The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under this title or title xviii. (7) Limitation on charges in case of medicaid-eligible individuals.— autobiography (A) In general.—A nursing facility may not impose charges, for certain medicaid-eligible individuals for nursing facility services covered by the State under its plan under this title, that exceed the payment amounts established by the State. (B) Certain medicaid individuals defined.—In subparagraph (A the term certain medicaid-eligible individual means an individual who is entitled to medical assistance for nursing facility services in the facility under this title but with respect to whom such benefits are not being paid because, in determining.
(ii) no additional services required.—Subparagraph (A) shall not be construed as requiring a state to offer additional services on behalf of a resident than are otherwise provided under the State plan. (5) Admissions Policy.— (A) Admissions.—With respect to admissions practices, a nursing facility must— (i) (I) not require individuals applying to reside or residing in the facility to waive their rights to benefits under this title or title xviii, (II) subject to subparagraph (b v not. (B) Construction.— (i) no preemption of stricter standards.—Subparagraph (A) shall not be construed as preventing States or political subdivisions therein from fuller prohibiting, under State or local law, the discrimination against individuals who are entitled to medical assistance under the State plan with respect to admissions. (ii) Contracts with legal representatives.—Subparagraph (a ii) shall not be construed as preventing a facility from requiring an individual, who has legal access to a residents income or resources available to pay for care in the facility, to sign a contract (without incurring personal financial. (iii) Charges for additional services requested.—Subparagraph (a iii) shall not be construed as preventing a facility from charging a resident, eligible for medical assistance under the State plan, for items or services the resident has requested and received and that are not specified in the. (iv) Bona fide contributions.—Subparagraph (a iii) shall not be construed as prohibiting a nursing facility from soliciting, accepting, or receiving a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the resident (or potential resident but only to the extent. (v) Treament of continuing care retirement communities admission contracts.—Notwithstanding subclause (II) of subparagraph (a i subject to subsections (c) and (d) of section 1924, contracts for admission to a state licensed, registered, certified, or equivalent continuing care retirement community or life care community, including services.
(F) Continuing rights in case of voluntary withdrawal from participation.— (i) In general.—In the case of a nursing facility that voluntarily withdraws from participation in a state plan under this title but continues to provide services of the type provided by nursing facilities— (I) the. Nothing in this subparagraph shall be construed as affecting any requirement of a participation agreement that a nursing facility provide advance notice to the State or the secretary, or both, of its intention to terminate the agreement. (ii) Information for new residents.—The information described in this clause for a resident is the following: (I) The facility is not participating in the program under this title with respect to that resident. (II) The facility may transfer or discharge the resident from the facility at such time as the resident is unable to pay the charges of the facility, even though the resident may have become eligible for medical assistance for nursing facility services under this title. (iii) Continuation of payments and oversight authority.—Notwithstanding any other provision of this title, with respect to the residents described in clause (i i a participation agreement of a facility described in clause (i) is deemed to continue in effect under such plan after the effective. (iv) no application to new residents.—This paragraph (other than subclause (III) golf of clause (i) shall not apply to an individual who begins residence in a facility on or after the effective date of the withdrawal from participation under this subparagraph. (3) Access and visitation rights.—A nursing facility must— (A) permit immediate access to any resident by any representative of the secretary, by any representative of the State, by an ombudsman or agency described in subclause (ii (iii or (IV) of paragraph (2 b iii. (4) Equal access to quality care.— (A) In general.—A nursing facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services required under the State plan for all individuals regardless of source of payment. (B) Construction.— (i) Nothing prohibiting any charges for non-medicaid patients.—Subparagraph (A) shall not be construed as prohibiting a nursing facility from charging any amount for services furnished, consistent with the notice in paragraph (1 B) describing such charges.
(ii) Timing of notice.—The notice under clause (i I) must be made at least 30 days in advance of the residents transfer or discharge except— (I) in a case described in clause (iii) or (iv) of subparagraph (A (II) in a case described in clause. In the case of such exceptions, notice must be given as many days before the date of the transfer or discharge as is practicable. (iii) Items included in notice.—Each notice under clause (i) must include— (I) for transfers or discharges effected on or after October 1, 1989, notice of the residents right to appeal the transfer or discharge under the State process established under subsection (e 3 (II) the. (C) Orientation.—A nursing facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility. (D) Notice on bed-hold policy and readmission.— (i) Notice before transfer.—Before a resident of a nursing facility is transferred for hospitalization or therapeutic leave, a nursing facility must provide written information to the resident and an immediate family member or legal representative concerning— (I) the. (ii) Notice upon transfer.—At the time of transfer of a resident to a hospital or for therapeutic leave, a nursing facility must provide written notice to the resident and an immediate family member or legal representative of the duration of any period described in clause. (iii) Permitting resident to return.—A nursing facility must establish and follow a written policy under which a resident— (I) who is eligible for medical assistance for nursing facility services under a state plan, (II) who is transferred from the facility for hospitalization or therapeutic leave. (E) Information respecting advance directives.—A nursing facility must comply with the requirement of section 1902(w) (relating to maintaining written policies and procedures respecting advance directives).
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Clause (iii) shall not be construed as requiring the provision of a private room. A residents exercise of a right to refuse transfer under clause harry (x) shall not affect the residents eligibility or entitlement to medical assistance under this title thesis or a states entitlement to federal medical assistance under this title with respect to services furnished to such. (B) Notice of rights.—A nursing facility must— (i) inform each resident, orally and in writing at the time of admission to the facility, of the residents legal rights during the stay at the facility and of the requirements and procedures for establishing eligibility for medical. The written description of legal rights under this subparagraph shall include a description of the protection of personal funds under paragraph (6) and a statement that a resident may file a complaint with a state survey and certification agency respecting resident abuse and neglect and. (C) Rights of incompetent residents.—In the case of a resident adjudged incompetent under the laws of a state, the rights of the resident under this title shall devolve upon, and, to the extent judged necessary by a court of competent jurisdiction, be exercised by, the.
(D) Use of psychopharmacologic drugs.— Psychopharmacologic drugs may be administered only on the orders of a physician and only as part of a plan (included in the written plan of care described in paragraph (2) designed to eliminate or modify the symptoms for which the. (2) Transfer and discharge rights.— (A) In general.—A nursing facility must permit each resident to remain in the facility and must not transfer or discharge the resident from the facility unless— (i) the transfer or discharge is necessary to meet the residents welfare and the. In each of the cases described in clauses (i) through (iv the basis for the transfer or discharge must be documented in the residents clinical record. In the cases described in clauses (i) and (ii the documentation must be made by the residents physician, and in the case described in clause (iv) the documentation must be made by a physician. For purposes of clause (v in the case of a resident who becomes eligible for assistance under this title after admission to the facility, only charges which may be imposed under this title shall be considered to be allowable. (B) Pre-transfer and pre-discharge notice.— (i) In general.—Before effecting a transfer or discharge of a resident, a nursing facility must— (I) notify the resident (and, if known, an immediate family member of the resident or legal representative) of the transfer or discharge and the reasons.
(c) Requirements Relating to residents Rights.— (1) General rights.— (A) Specified rights.—A nursing facility must protect and promote the rights of each resident, including each of the following rights: (i) Free e right to choose a personal attending physician, to be fully informed in advance. (ii) Free from restraints.—The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the residents medical symptoms. Restraints may only be imposed— (I) to ensure the physical safety of the resident or other residents, and (II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used (except in emergency circumstances. (iii) Privacy.—The right to privacy with regard to accommodations, medical treatment, written and telephonic communications, visits, and meetings of family and of resident groups. (iv) Confidentiality.—The right to confidentiality of personal and clinical records and to access to current clinical records of the resident upon request by the resident or the residents legal representative, within 24 hours (excluding hours occurring during a weekend or holiday) after making such. (v) Accommodation of needs.—The right— (I) to reside and receive services with reasonable accommodation of individual needs and preferences, except where the health or safety of the individual or other residents would be endangered, and (II) to receive notice before the room or roommate.
(vi) Grievances.—The right to voice grievances with respect to treatment or care that is (or fails to be) furnished, without discrimination or reprisal for voicing the grievances and the right to prompt efforts by the facility to resolve grievances the resident may have, including those. (vii) Participation in resident and family groups.—The right of the resident to organize and participate in resident groups in the facility and the right of the residents family to meet in the facility with the families of other residents in the facility. (viii) Participation in other activities.—The right of the resident to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility. (ix) Examination of survey results.—The right to examine, upon reasonable request, the results of the most recent survey of the facility conducted by the secretary or a state with respect to the facility and any plan of correction in effect with respect to the facility. (x) Refusal of certain transfers.—The right to refuse a transfer to another room within the facility, if a purposes of the transfer is to relocate the resident from a portion of the facility that is not a skilled nursing facility (for purposes of title xviii). (xi) Other rights.—Any other right established by the secretary.
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(F) Nurse aide defined.—In this paragraph, the term nurse aide means any individual providing nursing or nursing-related services to residents in a nursing facility, but does not include an individual— (i) who is a licensed health professional (as legs defined in subparagraph (G) or a registered. Such term includes an individual who provides such services through an agency or under a contract with the facility. (G) Licensed health professional defined.—In this paragraph, the term licensed health professional means a physician, physician assistant, nurse practitioner, physical, speech, or occupational therapist, physical or occupational therapy assistant, registered professional nurse, licensed practical nurse, or licensed or certified social worker. (6) Physician supervision and clinical records.—A nursing facility must— (A) require that the health care of every resident be provided under the supervision of a physician (or, at the option of a state, under the supervision of a nurse practitioner, clinical nurse specialist, or physician. (7) Required social services.—In the case of a nursing facility with more than 120 beds, the facility must have at least one social worker (with at least a bachelors degree in social work or similar professional qualifications) employed full-time to provide or assure the provision. (8) Information on nurse staffing.— (A) In general.—A nursing facility shall post daily for resumes each shift the current number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. The information shall be displayed in a uniform manner (as specified by the secretary) and in a clearly visible place. (B) Publication of data.—A nursing facility shall, upon request, make available to the public the nursing staff data described in subparagraph (A).
In granting or assignments renewing a waiver, a state may require the facility to use other qualified, licensed personnel. (iii) Assumption of waiver authority by secretary.—If the secretary determines that a state has shown a clear pattern and practice of allowing waivers in the absence of diligent efforts by facilities to meet the staffing requirements, the secretary shall assume and exercise the authority. (5) Required training of nurse aides.— (A) In general.— (i) Except as provided in clause (ii a nursing facility must not use on a full-time basis any individual as a nurse aide in the facility on or after October 1, 1990, for more than. (ii) A nursing facility must not use on a temporary, per diem, leased, or on any other basis other than as a permanent employee any individual as a nurse aide in the facility on or after January 1, 1991, unless the individual meets the requirements. (B) Offering competency evaluation programs for current employees.—A nursing facility must provide, for individuals used as a nurse aide 180 by the facility as of January 1, 1990, for a competency evaluation program approved by the State under subsection (e 1) and such preparation. (C) Competency.—The nursing facility must not permit an individual, other than in a training and competency evaluation program approved by the State, to serve as a nurse aide or provide services of a type for which the individual has not demonstrated competency and must not. (D) re-training required.—For purposes of subparagraph (a if, since an individuals most recent completion of a training and competency evaluation program, there has been a continuous period of 24 consecutive months during none of which the individual performed nursing or nursing-related services for monetary compensation. (E) Regular in-service education.—The nursing facility must provide such regular performance review and regular in-service education as assures that individuals used as nurse aides are competent to perform services as nurse aides, including training for individuals providing nursing and nursing-related services to residents with cognitive.
retardation or developmental disability authority, as applicable, promptly after a significant change in the physical or mental condition of a resident who is mentally ill or mentally retarded. (F) Requirements relating to preadmission screening for mentally ill and mentally retarded individuals.—Except as provided in clauses (ii) and (iii) of subsection (e 7 a a nursing facility must not admit, on or after January 1, 1989, any new resident who— (i) is mentally ill. A state mental health authority and a state mental retardation or developmental disability authority may not delegate (by subcontract or otherwise) their responsibilities under this subparagraph to a nursing facility (or to an entity that has a direct or indirect affiliation or relationship with such. (4) Provision of services and activities.— (A) In general.—to the extent needed to fulfill all plans of care described in paragraph (2 a nursing facility must provide (or arrange for the provision of)— (i) nursing and related services and specialized rehabilitative services to attain. The services provided or arranged by the facility must meet professional standards of quality. (B) qualified persons providing services.—Services described in clauses (i (ii (iii (iv and (vi) of subparagraph (A) must be provided by qualified persons in accordance with each residents written plan of care. (C) Required nursing care; facility waivers.— (i) General requirements.—With respect to nursing facility services provided on or after October 1, 1990, a nursing facility— (I) except as provided in clause (ii must provide 24-hour licensed nursing services which are sufficient to meet the nursing needs. (ii) waiver by state.—to the extent that a facility is unable to meet the requirements of clause (i a state may waive such requirements with respect to the facility if— (I) the facility demonstrates to the satisfaction of the State that the facility has been. A waiver under this clause shall be subject to annual review and to the review of the secretary and subject to clause (iii) shall be accepted by the secretary for purposes of this title to the same extent as is the States certification of the.
(ii) Penalty for falsification.— (I) An individual who willfully and knowingly certifies under clause (i) a material and false statement in a resident assessment is subject to a civil money penalty of not more than 1,000 with respect to each golf assessment. (II) An individual who willfully and knowingly causes another individual to certify under clause (i) a material and false statement in a resident assessment is subject to a civil money penalty of not more than 5,000 with respect to each assessment. (III) The provisions of section 1128A (other than subsections (a) and (b) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). (iii) Use of independent assessors.—If a state determines, under a survey under subsection (g) or otherwise, that there has been a knowing and willful certification of false assessments under this paragraph, the State may require (for a period specified by the State) that resident assessments. (C) Frequency.— (i) In general.—Such an assessment must be conducted— (I) promptly upon (but no later than not later than 14 days after the date of) admission for each individual admitted on or after October 1, 1990, and by not later than October 1, 1991. (ii) Resident review.—The nursing facility must examine each resident no less frequently than once every 3 months and, as appropriate, revise the residents assessment to assure the continuing accuracy of the assessment. (D) Use.—The results of such an assessment shall be used in developing, reviewing, and revising the residents plan of care under paragraph (2).
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1396r (a nursing, facility defined.—In this title, the term nursing facility means an institution (or a distinct part of an institution) which— (1) is real primarily engaged in providing to residents— (A) skilled nursing care and related services for residents who require medical or nursing care. Such term also includes any facility which is located in a state on an Indian reservation and is certified by the secretary as meeting the requirements of paragraph (1) and subsections (b (c and (d). (b requirements, relating to Provision of Services.— (1 quality of life.— (A) In general.—A nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident. (B) quality assessment and assurance.—A nursing facility must maintain a quality assessment and assurance committee, consisting of the director of nursing services, a physician designated by the facility, and at least 3 other members of the facilitys staff, which (i) meets at least quarterly. A state or the secretary may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this subparagraph. (2) Scope of services and activities under plan of care.—A nursing facility must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care which— (A) describes the medical. (3) Residents assessment.— (A) Requirement.—A nursing facility must conduct a comprehensive, accurate, standardized, reproducible assessment of each residents functional capacity, which assessment— (i) describes the residents capability to perform daily life functions and significant impairments in functional capacity; (ii) is based on a uniform minimum. (B) Certification.— (i) In general.—Each such assessment must be conducted or coordinated (with the appropriate participation of health professionals) by a registered professional nurse who signs and certifies the completion of the assessment. Each individual who completes a portion of such an assessment shall sign and certify as to the accuracy of that portion of the assessment.