Medicaid Nursing Home Rules
Medicaid is an assistance program jointly administered by the federal and state governments. It is meant for low-income individuals and categorically needy people of any age group. It covers almost half of the nation's nursing home expenses, and spent about $43 billion on nursing homes in 2001, according to Medicare.gov.
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Nursing Homes
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Medicaid has special rules that nursing homes must follow in order to receive Medicaid funding, or in order to be considered a place where a Medicaid patient in need of nursing home care can live. The Health Care Financing Administration (HCFA), the body that governs the conduct of nursing homes, defines a nursing home as a facility that has in its ranks skilled personnel needed for providing professional medical care of its patients. Unless nursing homes are run by charitable organizations and trusts, religious institutions or the Veterans Affairs Administration, they run for profit. Both "for-profit" and not-for-profit nursing homes receive some of their funding from federal and state governments, and part of this funding often comes from payment for Medicaid patients.
Basic Eligibility
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In order to be eligible for funding under Medicaid, nursing homes have to meet certain requirements. These mostly pertain to facilities and infrastructure. Also important are supplementary conditions, such as provision of social interaction; nutritional and fluid intake administration of its patients; and support services, such as clean laundry, physical rehabilitation facilities, physiotherapy and housekeeping.
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Staffing
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In order to receive Medicaid funding, a nursing home has to meet certain staffing requirements. The home should have 24-hour skilled nursing care with a registered nurse (RN) or licensed practical nurse (LPN) on duty at all times of the day. The nursing home also should have at least eight hours of nursing supervision from an RN or LPN per day.
The same team of nurses and certified nursing assistants (CNAs) should work with the same resident at least four to five days in a week. The nursing home also has to have a full-time social worker, and the nursing home's management team must have at least a year of experience.
Physical Requirements
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The nursing home should have a separate unit for special services like dementia, rehabilitation and ventilator use. The nursing home should have good lighting, be free of bad odor, be cleanly maintained, and have room temperatures that are comfortable for the residents. Staff members should wear their name plates and be polite and understanding, and the nursing home should do checks on their staff regularly. The home also should provide adequate facilities to residents, including but not limited to personal phones, choice of roommates, personal storage and windows.
Checks on Standards
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State authorities carry out periodic checks to assess the quality of care being given by nursing homes that have received Medicaid funding. When the state receives complaints of poor standards of health care administered by these facilities, the state issues notices. The state agencies are responsible for estimating whether a nursing home meets the required standards. When poor standards continue, the facility is taken off the list of certified nursing homes, and penalties are imposed on it.
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