42 U.S.C. 1396r: Requirements for nursing facilities

2021

• Pub. L. 117–2 added subsec. (k). (American Rescue Plan Act of 2021) Law text · (k)

2010

• Pub. L. 111–148, §6121(b)(2), inserted concluding provisions. (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–148, §6101(c)(1)(B), redesignated subpar. (C) as (B) and struck out former subpar. (B) which related to required notice to a State licensing agency of change in ownership, control interest, management, or certain positions of responsibility for a nursing facility. (Patient Protection and Affordable Care Act) Law text · (d), (C)
• Pub. L. 111–148, §6103(c)(2), added subpar. (V). (Patient Protection and Affordable Care Act) Law text · (d)
• Pub. L. 111–148, §6121(b)(1), inserted " (including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training, and patient abuse prevention training" before ", (II)". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §6103(b)(3), added par. (10). (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §6103(b)(2)(A), added subpar. (E). (Patient Protection and Affordable Care Act) Law text · (g)
• Pub. L. 111–148, §6111(b)(1), designated existing provisions as subcl. (I), inserted heading, substituted "Subject to subclause (II), the Secretary" for "The Secretary", and added subcls. (II) to (IV). (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §6111(b)(2), which directed insertion of "(ii)(IV)," after "(i)," in subsec. "(h)(5)(8)" of this section, was executed to subsec. (h)(8), to reflect the probable intent of Congress. Subsec. (h)(5) does not contain "(i),". (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §6103(b)(1), added subsec. (i) and redesignated former subsec. (i) as (j). (Patient Protection and Affordable Care Act) Law text · (i), (j)

2006

• Pub. L. 109–432 substituted "subparagraph (B)(v)" for "clause (v)". (Tax Relief and Health Care Act of 2006) Law text · (c)
• Pub. L. 109–171, §6015(a)(1), inserted "subject to clause (v)" after "(II)". (Deficit Reduction Act of 2005) Law text · (c)
• Pub. L. 109–171, §6015(a)(2), added cl. (v). (Deficit Reduction Act of 2005) Law text · (c)

2003

• Pub. L. 108–173, §932(c)(2)(A), substituted "subparagraphs (C) and (D)" for "subparagraph (C)" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §932(c)(2)(B), added subpar. (D). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)

2000

• Pub. L. 106–554 added par. (8). (Consolidated Appropriations Act, 2001) Law text · (b)
• Pub. L. 106–402 substituted "subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000" for "part C of the Developmental Disabilities Assistance and Bill of Rights Act". (Developmental Disabilities Assistance and Bill of Rights Act of 2000) Law text · (c)

1999

• Pub. L. 106–113, §1000(a)(6) [title VI, §608(p)(1)], struck out "not later than" before "14 days". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (b)
• Pub. L. 106–4 added subpar. (F). Law text · (c)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(p)(2)], inserted closing parenthesis after "section 1320a–3 of this title". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (d)

1997

• Pub. L. 105–15, §1(1), inserted "subject to subparagraph (C)," after "(iii)". Law text · (f)
• Pub. L. 105–15, §1(2), added subpar. (C). Law text · (f)
• Pub. L. 105–33, §4755(b), added subpar. (D) and redesignated former subpar. (D) as (E). (Balanced Budget Act of 1997) Law text · (g), (E)
• Pub. L. 105–33, §4754(a), inserted "and" at end of cl. (i), substituted a period for ", and" at end of cl. (ii), and struck out cl. (iii) which read as follows: "the State agrees to repay to the Federal Government payments received under this subparagraph if the corrective action… (Balanced Budget Act of 1997) Law text · (h)

1996

• Pub. L. 104–315, §2(a), inserted at end "In addition, a nursing facility shall notify the State mental health authority or State mental retardation or developmental disability authority, as applicable, promptly after a significant change in the physical or mental condition of a r… Law text · (b)
• Pub. L. 104–315, §1(a)(1)(A), struck out "annual" before "resident review" in heading. Law text · (e)
• Pub. L. 104–315, §2(b), added cl. (iii). Law text · (e)
• Pub. L. 104–315, §1(a)(1)(B), struck out cl. (iii) which related to frequency of reviews as annual, preadmission, and initial. Law text · (e)
• Pub. L. 104–315, §1(a)(2), struck out "annual" before "review" in heading. Law text · (e)

1992

• Pub. L. 102–375 substituted "title III or VII of the Older Americans Act of 1965 in accordance with section 712 of the Act" for "section 307(a)(12) of the Older Americans Act of 1965". · (c), (g)

1990

• Pub. L. 101–508, §4801(e)(2), inserted at end "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." · (b)
• Pub. L. 101–508, §4801(e)(3), substituted "not later than 14 days" for "4 days". · (b)
• Pub. L. 101–508, §4801(b)(8), substituted "specialized services" for "active treatment" in cls. (i) and (ii). · (b)
• Pub. L. 101–508, §4801(b)(4)(A), inserted at end "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 dire… · (b)
• Pub. L. 101–508, §4801(b)(2)(A), substituted "Except as provided in clauses (ii) and (iii) of subsection (e)(7)(A), a nursing facility" for "A nursing facility" in introductory provisions. · (b)
• Pub. L. 101–508, §4801(e)(4), added cl. (vii). · (b)
• Pub. L. 101–508, §4801(e)(5)(A), substituted "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" for "A State may waive the requirement of subclause (I) or (II) of clause (i) wit… · (b)
• Pub. L. 101–508, §4801(e)(5)(B)–(D), which directed amendment of cl. (ii) by adding subcls. (IV) and (V) at the end, was executed by adding subcls. (IV) and (V) after subcl. (III) and before concluding provisions to reflect the probable intent of Congress. · (b), (V)
• Pub. L. 101–508, §4801(a)(2), designated existing provision as cl. (i), substituted "Except as provided in clause (ii), a nursing facility" for "A nursing facility" and "on a full-time basis" for "(on a full-time, temporary, per diem, or other basis)", redesignated former cls. (i… · (b)
• Pub. L. 101–508, §4801(a)(3), substituted "any State registry established under subsection (e)(2)(A) that the facility believes will include information" for "the State registry established under subsection (e)(2)(A) as to information in the registry". · (b)
• Pub. L. 101–508, §4801(a)(4), inserted before period at end ", or a new competency evaluation program". · (b)
• Pub. L. 101–508, §4801(e)(6), substituted "(G)) or a registered dietician" for "(G))". · (b)
• Pub. L. 101–508, §4801(d)(1), inserted before semicolon at end "(or, at the option of a State, under the supervision of a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physic… · (b)
• Pub. L. 101–508, §4801(e)(8)(B), inserted at end "A resident's exercise of a right to refuse transfer under clause (x) shall not affect the resident's eligibility or entitlement to medical assistance under this subchapter or a State's entitlement to Federal medical assistance und… · (c)
• Pub. L. 101–508, §4801(e)(9), inserted before period at end "and to access to current clinical records of the resident upon request by the resident or the resident's legal representative, within 24 hours (excluding hours occurring during a weekend or holiday) after making suc… · (c)
• Pub. L. 101–508, §4801(e)(8)(A), added cl. (x) and redesignated former cl. (x) as (xi). · (c), (xi)
• Pub. L. 101–508, §4801(e)(10), inserted "including the notice (if any) of the State developed under subsection (e)(6)" after "in such rights)". · (c)
• Pub. L. 101–508, §4751(b)(2), added subpar. (E). · (c)
• Pub. L. 101–508, §4801(e)(7)(A), added par. (7) and redesignated former par. (7) as (8). · (c), (8)
• Pub. L. 101–508, §4801(e)(18), substituted "under subsection (f)(2)" for "under clause (i) or (ii) of subsection (f)(2)(A)". · (e)
• Pub. L. 101–508, §4801(e)(12)(A), inserted ", or any individual described in subsection (f)(2)(B)(ii) or in subparagraph (B), (C), or (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989" after "in the State". · (e)
• Pub. L. 101–508, §4801(e)(12)(B), added subpar. (C). · (e)
• Pub. L. 101–508, §4801(b)(2)(B), designated existing provision as cl. (i), inserted cl. (i) heading, and added cls. (ii) and (iii). · (e)
• Pub. L. 101–508, §4801(b)(8), substituted "specialized services" for "active treatment". · (e), (ii)
• Pub. L. 101–508, §4801(b)(4)(B), added cl. (iv). · (e)
• Pub. L. 101–508, §4801(b)(8), substituted "specialized services" for "active treatment" wherever appearing. · (e)
• Pub. L. 101–508, §4801(b)(5)(A), added cl. (iv). · (e)
• Pub. L. 101–508, §4801(b)(3)(A), struck out "where failure to conduct preadmission screening" after "Denial of payment" in heading, designated existing provisions as cl. (i), inserted cl. (i) heading, and added cl. (ii). · (e)
• Pub. L. 101–508, §4801(b)(8), substituted "specialized services" for "active treatment". · (e)
• Pub. L. 101–508, §4801(b)(6), inserted at end "The State may revise such an agreement, subject to the approval of the Secretary, before October 1, 1991, but only if, under the revised agreement, all residents subject to the agreement who do not require the level of services of such a facility are d… · (e)
• Pub. L. 101–508, §4801(b)(3)(B), substituted "the requirements of subparagraphs (A) through (C) of this paragraph" for "the requirement of this paragraph". · (e)
• Pub. L. 101–508, §4801(b)(7), substituted "serious mental illness (as defined by the Secretary in consultation with the National Institute of Mental Health)" for "primary or secondary diagnosis of mental disorder (as defined in the Diagnostic and Statistical Manual of Mental D… · (e)
• Pub. L. 101–508, §4801(b)(8), substituted "specialized services" for "active treatment". · (e)
• Pub. L. 101–508, §4801(a)(5)(B), inserted "who is employed by (or who has received an offer of employment from) a facility on the date on which the aide begins either such program" after "nurse aide". · (f)
• Pub. L. 101–508, §4801(a)(5)(A), (C), (D), added subcl. (III). · (f)
• Pub. L. 101–508, §4801(a)(7), inserted "(through subcontract or otherwise)" after "may not delegate" in last sentence. · (f)
• Pub. L. 101–508, §4801(a)(6)(A), amended subcl. (I) generally. Prior to amendment, subcl. (I) read as follows: "offered by or in a nursing facility which has been determined to be out of compliance with the requirements of subsection (b), (c), or (d) of this section, with… · (f)
• Pub. L. 101–508, §4801(e)(13), inserted at end "A State shall not make a finding that an individual has neglected a resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual." · (g)
• Pub. L. 101–508, §4801(e)(14), substituted "deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans" for "deficiencies and plans". · (g)
• Pub. L. 101–508, §4801(e)(15), substituted "or of any adverse action taken against a nursing facility under paragraphs (1), (2), or (3) of subsection (h), with respect" for "with respect". · (g)

1989

• Pub. L. 101–239, §6901(b)(1)(A), substituted "October 1, 1990" for "January 1, 1990" in introductory provisions. · (b)
• Pub. L. 101–239, §6901(b)(1)(B), substituted "January 1, 1990" and "October 1, 1990" for "July 1, 1989" and "January 1, 1990", respectively. · (b)
• Pub. L. 101–239, §6901(d)(4)(A), substituted "Secretary until such an order could reasonably be obtained)" for "Secretary) until such an order could reasonably be obtained". · (c)
• Pub. L. 101–239, §6901(d)(4)(B), substituted "accommodation" for "accommodations". · (c)
• Pub. L. 101–239, §6901(d)(4)(C), substituted "and content of the curriculum" for ", content of the curriculum". · (f)
• Pub. L. 101–239, §6901(b)(3)(A), inserted "care of cognitively impaired residents," after "social service needs,". · (f)
• Pub. L. 101–239, §6901(b)(3)(B), substituted "recognition of mental health and social service needs, care of cognitively impaired residents" for "cognitive, behavioral and social care". · (f)
• Pub. L. 101–239, §6901(b)(3)(C), (D), added cl. (iv). · (f)
• Pub. L. 101–239, §6901(b)(4)(A), substituted "July 1, 1989" for "January 1, 1989". · (f)
• Pub. L. 101–239, §6901(d)(4)(D), substituted "not longer than 6 months after the effective date of the findings" for "not longer than 6 months". · (h)
• Pub. L. 101–239, §6901(d)(1), inserted at end "The provisions of this subsection shall apply to a nursing facility (or portion thereof) notwithstanding that the facility (or portion thereof) also is a skilled nursing facility for purposes of subchapter XVIII." · (h)

1988

• Pub. L. 100–360, §411(l)(2)(B), struck out "in the case of a resident eligible for benefits under this subchapter," before "uses an instrument". · (b)
• Pub. L. 100–360, §411(l)(2)(A), as amended by Pub. L. 100–485, §608(d)(27)(C), struck out "in the case of a resident eligible for benefits under part A of subchapter XVIII of this chapter," before "includes the identification of medical problems". · (b)
• Pub. L. 100–360, §411(l)(2)(C), amended subcl. (III) generally. Prior to amendment, subcl. (III) read as follows: "The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penaltie… · (b)
• Pub. L. 100–360, §411(l)(3)(A)(i), inserted "professional" after "registered". · (b)
• Pub. L. 100–360, §411(l)(3)(A)(i)–(iv), in heading, substituted "(ii) Waiver" for "(ii) Facility waivers.—(i) Waiver", in subcl. (III), inserted "professional" after "registered", and in concluding provisions, substituted "clause (iii)" for "clause (ii)" and "use" for "employ… · (b)
• Pub. L. 100–360, §411(l)(3)(A)(v), (vi), substituted "(iii) Assumption" for "(ii) Assumption" in heading and "exercise" for "excercise" in text. · (b)
• Pub. L. 100–360, §411(l)(3)(B), which directed amendment of subpar. (A) by striking "subparagraph (E)" and inserting "subparagraph (F)", could not be executed because of prior amendment by Pub. L. 100–360, §411(l)(2)(D)(i), see Amendment note below. · (b)
• Pub. L. 100–360, §411(l)(2)(D)(i), as amended by Pub. L. 100–485, §608(d)(27)(D), struck out ", who is not a licensed health professional (as defined in subparagraph (E))," after "any individual" in introductory provisions. · (b)
• Pub. L. 100–360, §411(l)(2)(D)(ii), substituted "nursing or nursing-related services" for "such services". · (b)
• Pub. L. 100–360, §411(l)(2)(D)(iii), inserted "physical or occupational therapy assistant," after "occupational therapist,". · (b)
• Pub. L. 100–360, §303(a)(2), inserted before semicolon at end "and of the requirements and procedures for establishing eligibility for medical assistance under this subchapter, including the right to request an assessment under section 1396r–5(c)(1)(B) of this title". · (c)
• Pub. L. 100–360, §411(l)(2)(F), substituted "for a stay at the facility" for "an allowable charge imposed by the facility for an item or service requested by the resident and for which a charge may be imposed consistent with this subchapter and subchapter XVIII of this chapter… · (c)
• Pub. L. 100–360, §411(l)(3)(C)(iii), as added by Pub. L. 100–485, §608(d)(27)(E), substituted "responsible" for "responsibile". · (c)
• Pub. L. 100–360, §411(l)(2)(G), substituted "upon the written" for "once the facility accepts the written" in subpar. (A)(ii) and "Upon written" for "Upon a facility's acceptance of written" in subpar. (B). · (c)
• Pub. L. 100–360, §411(l)(6)(B), amended Pub. L. 100–203, §4212(b), see 1987 Amendment note below. · (c)
• Pub. L. 100–360, §411(l)(3)(C)(ii), as added by Pub. L. 100–485, §608(d)(27)(E), amended Pub. L. 100–203, §4211, see 1987 Amendment note below. · (e)
• Pub. L. 100–360, §411(l)(3)(D)(i), (ii), substituted "January 1, 1989" for "September 1, 1988" in subpar. (A) and "January" for "September" in subpar. (B). · (e)
• Pub. L. 100–360, §411(l)(2)(H), inserted after first sentence "The State shall make available to the public information in the registry." · (e)
• Pub. L. 100–360, §411(l)(2)(I), inserted "and discharges" after "transfers" in heading and two places in text. · (e)
• Pub. L. 100–360, §411(l)(3)(D)(iii), substituted "April 1, 1989" for "October 1, 1988". · (e)
• Pub. L. 100–360, §411(l)(3)(C)(ii), as added by Pub. L. 100–485, §608(d)(27)(E), amended Pub. L. 100–203, §4211, see 1987 Amendment note below. · (f)
• Pub. L. 100–360, §411(l)(3)(D)(iv), substituted "September" for "July" in introductory provisions. · (f)
• Pub. L. 100–360, §411(l)(2)(J), substituted "recognition of mental health and social service needs" for "cognitive, behavioral and social care". · (f)
• Pub. L. 100–360, §411(l)(2)(I), inserted "and discharges" after "transfers" in heading and in text. · (f)
• Pub. L. 100–360, §411(l)(2)(K), substituted "residents" for "patients". · (f)
• Pub. L. 100–360, §411(l)(2)(L)(ii), substituted "include" for "do not include". · (f)
• Pub. L. 100–360, §411(l)(5)(A)–(C), substituted "and timely review" for ", review,", inserted "or by another individual used by the facility in providing services to such a resident" after "a nursing facility", and substituted "The State shall, after notice to the individual invo… · (g)
• Pub. L. 100–360, §411(l)(5)(D), substituted "to issue regulations to carry out this subsection" for "to establish standards under subsection (f) of this section". · (g)
• Pub. L. 100–360, §411(l)(5)(E), amended third sentence generally. Prior to amendment, third sentence read as follows: "The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penalties … · (g)
• Pub. L. 100–360, §411(l)(5)(F), as added by Pub. L. 100–485, §608(d)(27)(I), substituted "practicable" for "practical". · (g)
• Pub. L. 100–360, §411(l)(6)(A), redesignated subpar. (C), relating to special surveys of compliance, as (D). · (g)
• Pub. L. 100–360, §411(l)(5)(G), formerly §411(l)(5)(F), as redesignated by Pub. L. 100–485, §608(d)(27)(I), substituted "on the basis of that survey" for "on that basis". · (g)
• Pub. L. 100–360, §411(l)(5)(H), formerly §411(l)(5)(G), as redesignated by Pub. L. 100–485, §608(d)(27)(I), struck out "chronically" after "enforcement actions against" in last sentence. · (g)
• Pub. L. 100–360, §411(l)(8)(A), made technical correction to directory language of Pub. L. 100–203, §4213(a), see 1987 Amendment note below. · (h)
• Pub. L. 100–360, §411(l)(8)(B)(i), substituted "paragraph (2)(A)(ii)"for "paragraph (2)(A)(i)" in last sentence. · (h)
• Pub. L. 100–360, §411(l)(8)(B)(ii), struck out "or otherwise" after "regulations". · (h)
• Pub. L. 100–360, §411(l)(7)(A), substituted ". The provisions of section 1320a–7a of this title (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under s… · (h)
• Pub. L. 100–360, §411(l)(8)(B)(iii), substituted "State or the Secretary, respectively" for "State and the Secretary". · (h)
• Pub. L. 100–360, §411(l)(7)(B), inserted "by such facilities" after "be made available". · (h)

1987

• Pub. L. 100–203, §4212(b), as amended by Pub. L. 100–360, §411(l)(6)(B), added par. (7). · (c)
• Pub. L. 100–203, §4211, which contained two subsecs. (c), the first of which amended this section and the second of which enacted provisions set out as a note below, was amended by Pub. L. 100–360, §411(l)(3)(C)(ii), to delete the designation, heading, and directory language of t… · (e), (f)
• Pub. L. 100–203, §4212(a), added subsec. (g). · (g)
• Pub. L. 100–203, §4213(a), as amended by Pub. L. 100–360, §411(l)(8)(A), added subsec. (h). · (h)
• Pub. L. 100–203, §4216, added subsec. (i). · (i)