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A Closer Look at the Revised Nursing Facility Regulations
Quality of Care
Executive Summary Quality of Care
As CMS recognizes, the quality of care
The substantive requirements for quality of regulations reflect one of the fundamental
care are retained in the revised regulations, and principles of the federal Nursing Home Reform
the Centers for Medicare & Medicaid Services Law: that each resident is entitled to receive care
(CMS) affirms the regulations’ overriding goals: and services to attain and maintain the resident’s
supporting person-centered care and enabling “highest practicable physical, mental, and
each resident to attain or maintain his or her psychosocial well-being.” What matters is what
highest level of well-being. Finding all of the works for each resident; it is not sufficient that a
requirements presents a challenge, however. facility’s care and services work for most residents.
CMS has significantly reorganized the quality CMS interprets the “highest practicable” language
of care provisions, moving some provisions of the Reform Law to require, in regulations, that
to other regulatory sections, expanding the a resident not decline unless decline was medically
standards of the prior regulations, and adding unavoidable for that individual. In practice, a
several entirely new requirements. facility is out of compliance with quality of care
requirements if it fails to implement the resident’s
Introduction care plan, which CMS views as the facility’s
On September 28, 2016, CMS released revised determination of what care and services are needed,
nursing facility regulations. These regulations and must be provided, to enable the resident
govern most aspects of nursing facility operations to achieve his or her highest practicable level of
and apply nationwide to any nursing facility that functioning.
accepts Medicare or Medicaid reimbursement, or The revised quality of care section (42 C.F.R.
both. § 483.25) contains 14 specific subsections. Some
subsections are identical to the prior subsections
Acknowledgements (although sometimes with new numbering); some
Justice in Aging, the National Consumer Voice are revised and may also include new language;
for Quality Long-Term Care, and the Center for some are completely new; and some have been
Medicare Advocacy created this issue brief in moved elsewhere. While it may take some
collaboration. This brief is the tenth of a series searching to find the new locations of the quality
explaining important provisions of the revised of care standards, they are all present in the revised
regulations. regulations.
Office of the LTC Ombudsman
Version 1.0 September 2020
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