Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › GENERAL › Section 1181.504 - Background

Current through Register Vol. 54, No. 28, July 13, 2024
(a) In 1987,
					 Congress enacted major nursing home reform legislation affecting providers
					 participating in the Medicare and Medical Assistance Programs as part of
					 OBRA-87. Congress made some technical amendments to OBRA-87 in Title IV,
					 Subtitle B of the Medicare Catastrophic Coverage Act of 1988 (Pub. L. 100-360,
					 102 Stat. 768) (July 1, 1988). The nursing home reform provisions affecting the
					 Medical Assistance Program are codified at
					 42 U.S.C.A. §
												1396r, as part of Title XIX of the Social
					 Security Act.
(b) The nursing home
					 reform provisions enacted by Congress establish a timetable for action by
					 Federal and state agencies, as well as by providers, from 1987 through 1993,
					 including requirements for continuing approval of State plans. In a number of
					 cases, state agencies are required to take action even where Federal guidelines
					 required by the law are not timely promulgated. The reform provisions grew out
					 of concerns that the preexisting system of certification and review of
					 participating providers did not adequately deal with the quality of patient
					 care and did not sufficiently inform patients and providers of rights and
					 limitations. While most of the new requirements established by OBRA-87 do not
					 become effective until October 1, 1990, some are required to be implemented
					 prior to that date.
(c) Since the
					 enactment of OBRA-87, the Department in cooperation with the Departments of
					 Aging, Education, Health and State and the Governor's Budget Office and Office
					 of Policy, as well as with the responsible Federal agencies and representatives
					 of providers and recipients, has been conducting planning and development
					 activities necessary for the implementation of OBRA-87. These activities are
					 part of a program of change to improve the quality of care provided in nursing
					 facilities, to provide quality services in the most appropriate setting and to
					 increase public awareness of rights and limitations under the Medical
					 Assistance Program. The Department is the single State agency for the
					 administration of the Medical Assistance Program in this Commonwealth and is
					 therefore responsible for issuing information and regulations with respect to
					 the application of OBRA-87 to the Medical Assistance Program.
(d) OBRA-87 requires the Department to
					 implement certain provisions of the law on January 1, 1989. These provisions
					 are:
(1) Specification of nurse aide training
					 and competency evaluation programs and those competency evaluation programs
					 that the Department approves for use by providers and that meet requirements
					 established by the law. See 42 U.S.C.A. §
													1396r(e)(1)(A).
(2) Establishment of a registry of
					 individuals who satisfactorily complete a nurse aide training and competency
					 evaluation program or a nurse aide competency evaluation program approved by
					 the Department. See 42
					 U.S.C.A. §
													1396r(e)(2).
(3) Implementation of a preadmission
					 screening program, applicable to persons seeking admission to a provider
					 nursing facility, whether or not that person is applying for or receiving
					 Medical Assistance, to determine, based on criteria established by the Federal
					 government under OBRA-87, whether persons who are mentally ill or are mentally
					 retarded or have related disabilities require nursing facility services and, if
					 they do, whether they also require active treatment for their condition. See
					 42 U.S.C.A. §
													1396r(e)(7)(A).
(4) Implementation of an appeals process for
					 individuals who are adversely affected by the preadmission screening program
					 and wish to seek relief. See 42 U.S.C.A. §
													1396r(e)(7)(F).
(5) Enforcement of conditions of
					 participation established by OBRA-87 and effective for current nursing facility
					 providers.