Federal and MA Long-Term Care Laws & Regulations
Nursing homes operate under both federal and state law. Federal law mandates the framework for what the states must do, and states may impose additional regulations. State agencies may issue further regulations to supplement state laws.
- The basis for state nursing home regulations is the federal 1987 Omnibus Budget Reconciliation Act (“OBRA ‘87”). OBRA ‘87 applies to long-term facilities receiving Medicare or Medicaid funding.
- MA nursing home regulations are issued by the Department of Public Health (“DPH”).
- Regulations issued by the MA Attorney General fall under state Consumer Protection law, Ch. 93A, and these regulations are designed to supplement existing statutes and regulations. The Attorney General works and cooperates with other state and federal agencies in enforcing 940 CMR 4.00 and other regulations.
Federal Laws - OBRA ’87
42 CFR 483
42 CFR 483
Under federal law, nursing homes can be licensed under the Medicare program, Medicaid program, or both. Federal law describes nursing homes as skilled nursing facilities (“SNF”) under the Medicare program, and nursing facilities (“NF”) under the Medicaid program.
OBRA ‘87 is landmark legislation which forever changed our legal expectations of nursing homes and their care. The following excerpts are the essence of OBRA ’87,and support the law’s intent that a resident should not decline in health or well-being as a result of the way a nursing facility provides care.
§483.15 Quality of Life: a nursing home “…must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life...” Details to this requirement emphasize dignity, choice, and self-determination for residents.
§483.25 Quality of Care: a nursing home “…must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing [for each resident], in accordance with the comprehensive assessment and plan of care…” According to §483.20 Resident Assessment, a comprehensive care plan includes “…to the extent practicable, the participation of the resident, the resident's family or the resident's legal representative…”
MA assigns levels to nursing home beds based on the intensity of care provided in that area of the nursing home. Nursing homes are included in Levels 1 and 2, with Rest Homes in level 4.
Level 1 is generally considered the most intensive and skilled, meeting Medicare’s criteria as having the ability to provide for daily skilled care. Level 2 is also skilled, but less intensive and may or may not meet Medicare’s criteria for skilled care. Level 4 does not provide skilled care.
MA Trial Court Library
On-line library of MA laws; inquiries to law librarians - ask law librarians questions via email, phone, web chat); and other legal resources.
NH Regulations Plus (University of MN School of Public Health)
Searchable database by state and topic, with reference to related regulations.
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* Disclaimer: Please be advised that these links do not constitute the official version of these regulations. As is the case with all state regulations, official versions are available from the Secretary of the Commonwealth's State Publications and Regulations Division, through the State Bookstore. For the official version, contact the State Bookstore in Boston at (617) 727-2834.