Nursing Home Resident Protection Amendments of 1999
PL 106-4 (H.R.540), enacted 03/25/1999

PUBLIC LAW 106-4—MAR. 25, 1999 
113 STAT. 7 
Public Law 106-4 
106th Congress 
An Act 
To amend title XIX of the Social Security Act to prohibit transfers or discharges 
of residents of nursing facilities as a result of a voluntary withdrawal from 
participation in the Medicaid Program. 
Be it enacted 
by the Senate and House of Representatives 
of 
the United States of America in Congress 
assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the "Nursing Home Resident Protec-
tion Amendments of 1999". 
SEC. 2. RESTRICTIONS ON TRANSFERS OR DISCHARGES OF NURSING 
FACILITY RESIDENTS IN THE CASE OF VOLUNTARY WITH-
DRAWAL FROM PARTICIPATION UNDER THE MEDICAID 
PROGRAM. 
(a) I N GENERAL.—Section 1919(c)(2) of the Social Security Act 
(42 U.S.C. 1396r(c)(2)) is amended by adding at the end the follow-
ing new subpEiragraph: 
"(F) CONTINUING RIGHTS IN CASE OF VOLUNTARY WITH-
DRAWAL FROM PARTICIPATION.— 
"(i) I N GENERAL.—In the case of a nursing facility 
that voluntarily withdraws from pEirticipation in a 
State plan under this title but continues to provide 
services of the type provided by nursing facilities— 
"(I) the facilit3^s voluntary withdrawal from 
participation is not an acceptable basis for the 
transfer or discharge of residents of the facility 
who were residing in the facility on the day before 
the effective date of the withdrawal (including 
those residents who were not entitled to medical 
assistance as of such day); 
"(II) the provisions of this section continue 
to apply to such residents until the date of their 
discharge from the facility; and 
"(III) in the case of each individual who begins 
residence in the facility after the effective date 
of such withdrawal, the facility shall provide notice 
orally and in a prominent manner in writing on 
a sepairate page at the time the individual begins 
residence of the information described in clause 
(ii) and shall obtain from each such individual 
at such time an acknowledgmient of receipt of such 
information that is in writing, signed by the indi-
vidual, and separate from other documents signed 
by such individueJ. 
Mar. 25, 1999 
[H.R. 540] 
Nursing Home 
Resident 
Protection 
Amendments of 
1999. 
42 use 1305 
note. 
113 STAT. 8 
PUBLIC LAW 106-4—MAR. 25, 1999 
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 resi-
dent. 
"(II) The facility may transfer or discharge 
the resident from the facility at such time as the 
resident is unable to pay the chsirges of the facility, 
even though the resident may have become eligible 
for medic£d assistemce 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 
luider such plan after the effective date of the facility's 
voluntary withdrawal from participation under the 
State plan for purposes o
f
— 
"(I) receiving payments luider the State plan 
for nursing facility services provided to such resi-
dents; 
"(II) 
maintaining 
compligince 
with 
all 
applicable requirements of this title; and 
"(III) continuing to apply the survey, certifi-
cation, and enforcement authority provided under 
subsections (g) and (h) (including involimtary 
termination of a peirticipation agreement deemed 
continued under this clause). 
"(iv) No APPUCATION TO NEW RESIDENTS.—This 
paragraph (other than subclause (III) of clause (i)) 
shall not apply to an individual who begins residence 
in a facility on or after the effective date of the with-
drawal from participation under this subparagraph.". 
42 use I396r 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
J^ote- 
applies to voluntary withdrawsds from participation occurring on 
or Eifter the date of the enactment of this Act. 
Approved March 25, 1999. 
LEGISLATIVE HISTORY—H.R. 540 (S. 494): 
HOUSE REPORTS: No. 106-44 (Comm. on Commerce). 
SENATE REPORTS: No. 106-13 (Comm. on Finance). 
CONGRESSIONAL RECORD, Vol. 145 (1999): 
Mar. 9, 10, considered and passed House. 
Mar. 15, considered and passed Senate.