Appendix G.

TIMETABLE OF KEY MEDICAL ASSISTANCE RELATED
IMPLEMENTATION DATES UNDER OBRA-87, as amended, FOR HHS,
PROVIDER FACILITIES AND STATE AGENCIES

1988
7/1/88	Facilities:	Must provide LTC ombudsmen, physicians and State/Federal officials immediate access to residents.
7/1/88	HHS:	Issue regulation to define which costs can be charged to Medicaid eligible nursing facility residents’ personal fund, and which costs are included in the Medicaid payment amount.
9/1/88	HHS:	Establish requirements for approval of nurse aide training and competency evaluation programs.
10/1/88	HHS:	Establish guidelines for minimum standards for state appeals process for transferred and discharged residents.
10/1/88	HHS:	Develop minimum criteria for preadmission screening and annual resident review (PASARR) for mentally retarded and mentally ill residents of nursing facilities.
10/1/88	HHS:	Develop criteria for appeals process for residents adversely affected by PASARR process.
10/1/88	HHS:	Develop criteria to monitor state performance in granting nursing facilities waiver of 24-hour licensed professional nurse provision.
10/1/88	HHS:	Publish regulation regarding alternative remedies (sanctions) for nursing facilities out of compliance.
1989
1/1/89	States:	Must have in effect a preadmission screening program for mentally retarded and mentally ill patient placement determinations.
1/1/89	States:	Establish a nurse aide registry.
1/1/89	States:	Must establish appeals process for residents adversely affected by screening and review process for mentally retarded and mentally ill individuals.
1/1/89	States:	Specify approved nurse aide training and competency evaluation programs.
1/1/89	Facilities:	Must not admit any mentally retarded or mentally ill individuals unless screened by appropriate state authority and found to need level of care provided by facility.
1/1/89	HHS:	Specify minimum data set of core elements and common definitions for use by nursing facilities in conducting resident assessments. Establish guidelines for utilization of data set.
4/1/89	States/HHS:	Enter into agreement regarding alternative disposition plan for review/placement of mentally retarded or mentally ill residents needing active treatment but not level of care provided by facility in which they reside (NOTE: Since HCFA usually requires a 90-day period to review and approve such plans, states are advised to submit their alternative disposition plans to HCFA by January 1, 1989.
7/1/89	States:	Implementation and enforcement of standards for nursing facility administrators.
7/1/89	Facilities:	Must provide for nurse aid competency evaluation programs for nurse aides employed in facility as of July 1, 1989; and for any preparation needed to complete program by January 1, 1990.
10/1/89	States:	Must have appeals process in place for residents involuntarily transferred or discharged from nursing facilities on or after October 1, 1989.
10/1/89	States:	Establish alternative remedies (sanctions) for nursing facilities out of compliance.
10/1/89	Facilities:	Must notify residents of right to appeal all transfers and discharges.
1990
1/1/90	States:	Provide for review and reapproval of all nurse aide training and competency evaluation programs.
1/1/90	Facilities:	All nurses aides must have completed training and competency evaluation program if they are employed more than 4 months by facility.
1/1/90	HHS:	Develop, test and validate protocol for standard and extended survey of nursing facilities.
4/1/90	States:	Complete review of all mentally retarded and mentally ill residents currently residing in nursing facilities and determine and implement appropriate placement.
4/1/90	States:	Submit to HHS a state plan amendment which provides for appropriate payment adjustment to nursing facilities (which takes into account the cost of complying with nursing home reform provisions).
4/1/90	HHS:	Must designate one or more resident assessments which a state may specify for use by nursing facilities.
7/1/90	States:	Must specify resident assessment instrument to be used by nursing facilities.
7/1/90	States:	Must specify resident assessment instrument to be used by nursing facilities.
9/30/90	HHS:	Must review and approve/disapprove state plan amendments for payment adjustments to nursing facilities.
10/1/90	States:	Survey and Certification requirements become effective.
10/1/90	Facilities:	Must conduct resident assessment within 4 days for residents admitted on or after October 1, 1990 and must begin conducting annual resident assessments.
10/1/90	Facilities:	Must provide 24-hour/day licensed professional nursing services and full-time registered nurse services 7 days/week (unless waived). Distinction between SNF and ICF level of care eliminated.
1991
10/1/91	Facilities:	Resident assessment for all residents admitted to facility prior to October 1, 1990 must be completed.
1993
*1/1/93	HHS:	Evaluation of resident assessment process—report to Congress.

Source

The provisions of this Appendix G adopted December 23, 1988, effective January 1, 1989, 18 Pa.B. 5711.

Cross References

This section cited in 55 Pa. Code § 1181.505 (relating to discussion).