Nursing Home Quality Regulation

VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Facilities Regulation >> Nursing Home Quality Regulation


Medicaid is by far the largest payer for nursing home care. An Institute of Medicine study of nursing homes in the mid-1980’s resulted in concerns about inadequate treatment of mental health conditions, culminating in special legislation and new requirements targeted at that issue. The Nursing Home Reform Act of 1987 (NHRA) requires nursing homes to a) provide basic mental health services for all residents; b) give active mental health treatment to residents with serious mental illness and c) provide nurse’s aide training. The Duke Center for Health Policy and Inequalities Research has developed a draft working paper assessing the costs and benefits of LTC (long term care) facility accreditation and licensure regulation (pdf), which includes the following topics:

  • Medicare conditions of participation
  • Nursing Home Reform Act (OBRA ’97)
  • State accreditation and licensure

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