Federal and MA Nursing Home Laws & Regulations

Nearly all US nursing homes operate under both federal and state law. Federal regulations apply to long-term care facilities that receive Medicare and/or Medicaid funding, and individual states are at liberty to impose additional regulations to further protect nursing home residents. State agencies also may issue additional requirements to supplement state laws. Background, including links, to both federal and Massachusetts nursing home regulations follow.

Federal nursing home regulations are in the Code of Federal Regulations (CFR) Chapter 42, Part 483, Subpart B-Requirements for Long Term Care Facilities. These protections for nursing home residents were established in 1987 and revised in 2016 to reflect substantial advances in theory and practice of care delivery and safety made since the law’s inception. As mentioned, these federal regulations apply only to facilities that receive Medicare and/or Medicaid funding, the vast majority of nursing homes

Appendix PP of the State Operations Manual (SOM)  details federal nursing home survey protocols and interpretive guidelines to clarify the intent of the 42 CFR 483 regulations discussed above. All nursing home surveyors are required to use these protocols in assessing a nursing home’s compliance with federal regulations. Appendix PP will also help you better understand federal regulations. Interpretive guidelines are assigned to one or more related regulations arranged by a number prefaced with the letter “F” (called “F Tags”).

Massachusetts nursing home regulations 105 CMR 150.000, Licensing of Long-Term Care Facilities are issued by the Department of Public Health (“DPH”). As you’ll see, MA assigns “levels” to long-term care beds based on the intensity of care provided. Nursing homes are included in Levels 1 and 2. Level 1 is considered the most intensive care and meets Medicare’s daily skilled care criteria. Level 2 is also skilled, but less intensive and may or may not meet Medicare’s skilled care criteria.

Massachusetts Attorney General nursing home regulations, 940 CMR 4.00, fall under state Consumer Protection law, Ch. 93A, designed to supplement existing statutes and regulations. 940 CMR defines possible unfair or deceptive acts or practices in nursing. The Attorney General works and cooperates with other state and federal agencies in enforcing 940 CMR 4.00.

Massachusetts General Laws – Public Health: Chapter 111, Patients’ and Residents’ Rights: Section 70E address patients’ and residents’ rights covering a wide-range of facilities and issues. The law’s 5th paragraph states “…Every patient or resident of a facility shall have the right (c) to have all reasonable requests responded to promptly and adequately within the capacity of the facility;…” This regulation is especially helpful in situations not specifically addressed elsewhere in MA regulations. Here are some examples of reasonable requests and how this regulation can help you.

Examples of reasonable requests range from an everyday request, such as asking to have a pitcher of water easily accessible to a resident for proper hydration. To a more specific request such as asking to have the regular replacement of a resident’s feeding tube done at the nursing home (as medically allowed), instead of the hospital, to protect the resident from the stress of traveling to the hospital.

If a reasonable request is made and the facility does not respond promptly, adequately, or at all, document the process and ask the facility why. If the request is not “within the capacity of the facility” (maybe due to building constraints, etc.), the facility should cite the specific reason. However, if the request is within the capacity of the facility and the facility doesn’t follow-through, refer to your options and additional information under Dealing With Challenges.

The MA Trial Court Library is an on-line library of all Massachusetts laws that operates just like your neighborhood public library. You can ask questions to their librarians via email, phone, web chat, etc.

NH Regulations Plus (University of MN School of Public Health) is a searchable database by state and topic, with reference to related regulations.

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