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.


 See "Helpful Hints for Researching Regulations" at the end of this page.


Federal Laws - OBRA ’87
42 CFR 483 

(See "Appendix PP of the State Operations Manual" for the Interpretive Guidelines to these Federal Laws.)

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…”

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Appendix PP of the State Operations Manual

SOM - Appendix PP

(Interpretive Guidelines to Federal Laws - OBRA '87: 42 CFR 483)

Appendix PP of the State Operations Manual (SOM) will help you better understand the Federal nursing home regulations 42 CFR 483 discussed above.  Please note that this document covers Federal regulations, even though named "State".


The Centers for Medicare and Medicaid Services (“CMS”) establishes survey protocols (Appendix P) and Interpretive Guidelines (Appendix PP) to provide guidance to personnel conducting nursing home surveys.  These documents clarify the intent of the regulations, and all surveyors are required to use them in assessing compliance with Federal requirements. The purpose of the protocols and guidelines is to direct the surveyor’s attention to certain avenues for investigation in preparation for the survey, in conducting the survey, and in evaluation of the survey findings.


The interpretive Guidelines are sometimes called "F Tags", since the Guideline for each regulation is assigned a number beginning with the letter "F".


For additional background, see this link to the CMS website: Survey & Certification - Guidance to Laws & Regulations: Nursing Homes.

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Massachusetts Department of Public Health
* 105 CMR 150.000 Licensing of Long-Term Care Facilities 

(Double-check against MA Trial Court Library 105 CMR 150.000 which may be more current.)

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.  Rest Homes are 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.
Office of the Massachusetts Attorney General

* 940 CMR 4.00 Long Term Care Facilities

940 CMR defines certain unfair or deceptive acts or practices.  These regulations are designed to promote the protection, comfort, health and well-being of consumers of services provided by long-term care facilities, to be consistent with existing legal standards, and to be as responsive as possible to the constraints and administrative realities under which long-term care facilities operate.  940 CMR 4.00 is designed to supplement existing statutes and regulations.


Massachusetts General Laws - Public Health: Chapter 111, Patients' and Residents' Rights: Section 70E

This Law covers many types of facilities and issues, and "Patients' and Residents' Rights" start in the 5th paragraph: 

“…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 for situations not specifically addressed elsewhere in MA regulations.  Below are some examples of reasonable requests and how this regulation can help you.


Examples of reasonable requests can 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 and waiting at 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 for reasons why they didn't follow-through.  If the facility says that 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, see Problem Resolution for your options and additional information.


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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.


The research method used will depend upon whether the regulations are stored in a PDF file or a web page:


PDF File

Use the “Search” feature, and depending on your Adobe setup, either click the “binoculars” icon or use the Edit Menu and select the “Search” option.  Type a word or words that you’re researching in the Search box.  A list of the regulations that the “search word” is in will appear.  Click on an item in the list to go to the related regulation.


Web Page

Click on the Edit menu in your browser.  The last selection in the Edit menu is the “Find” feature which operates similar to the instructions explained above.  The “Find” feature does not create a list of related regulations.  But it will highlight the “Find” word on the web page, and by clicking on the icons next to the box, you can jump forward or backward to the next highlighted word.



* 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.




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