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Medicaid (Title XIX of the Social Security Act)
Requirements Related to Quality Measures, Notification and, Reporting


b.) Requirements Related to Quality Measures, Notification and Reporting

Every nursing facility must maintain a quality assessment and assurance committee that meets quarterly to identify issues needing quality improvement and to develop and implement appropriate plans of action to correct identified quality deficiencies.61  There must be methods for receiving, reviewing and investigating allegations of neglect and abuse and misappropriation of resident property by any nursing facility employee; if the state makes a finding confirming such allegations, it must notify the offending individual and the appropriate licensure authority. 62   A public nurse aide registry must be established that includes all documented findings of resident neglect or abuse or misappropriation of property, and any statement of the aide disputing the findings.63  The state must maintain procedures to investigate violations of all the requirements listed above and must also monitor facilities that are, were or are suspected to be non-compliant with these requirements.64  The state must notify the long-term care ombudsman of any non-compliance or of adverse actions taken against a nursing facility.65

The state will conduct regular surveys of the quality of care furnished by all nursing facilities that includes: 66

  • An audit of resident assessments for accuracy;
  • A review of plans of care for adequacy on the basis of resident assessments and;
  • A review of compliance with residents’ rights. 

Within two months, the Secretary will conduct validation surveys to determine whether the state’s survey was adequate.67  If the results of either survey show that a facility provided a substandard quality of care, an extended survey will be conducted to identify the policies and procedures that produced the problem and determine whether the facility has otherwise complied with all other nursing facility requirements.68  The state must also notify each affected resident’s attending physician, and any state board responsible for the licensing of the nursing facility administrator.69

All survey and certification information will be provided to the state’s fraud and abuse control unit and be made public.70 The facility must post the results of its most recent survey in an accessible location,71 removing any information identifying complainants or residents in any notices or reports.72  The state must also maintain a consumer-oriented website73 that includes:74

  • Inspection reports, complaint investigation reports and plans of correction;
  • Resident census data and data on the hours of care provided per resident per day;
  • Summary information on the number, type, severity, and outcome of substantiated complaints;
  • The number of adjudicated instances of criminal violations committed inside the facility by the employees of a facility and;
  • The number of violations or crimes committed outside of the facility that resulted in the serious bodily injury of an elder.



  • 61. Social Security Act § 1919(b)(1)(B), 42 U.S.C. 1396r(b)(1)(B).
  • 62. Social Security Act § 1919(g)(1)(C), 42 U.S.C. 1396r(g)(1)(C).
  • 63. Social Security Act § 1919(e)(2)(B), 42 U.S.C. 1396r(e)(2)(B).
  • 64. Social Security Act § 1919(g)(4), 42 U.S.C. 1396r(g)(4).
  • 65. Social Security Act § 1919(g)(5)(B), 42 U.S.C. 1396r(g)(5)(B).
  • 66. Social Security Act § 1919(g)(2)(A)(ii), 42 U.S.C. 1396r(g)(2)(A)(ii).
  • 67. Social Security Act § 1919(g)(3)(A), 42 U.S.C. 1396r(g)(3)(A).
  • 68. Social Security Act § 1919(g)(2)B), 42 U.S.C. 1396r(g)(2)(B).
  • 69. Social Security Act § 1919(g)(5)(C), 42 U.S.C. 1396r(g)(5)(C).
  • 70. Social Security Act § 1919(g)(5), 42 U.S.C. 1396r(g)(5).
  • 71. Social Security Act § 1919(c)(8), 42 U.S.C. 1396r(c)(8).
  • 72. Social Security Act § 1919(d)(1)(D), 42 U.S.C. 1396r(d)(1)(D).
  • 73. Social Security Act §1902(a)(9)(D), 42 U.S.C. 1396a(a)(9)(D).
  • 74. Social Security Act § 1919(i)(1)(A), 42 U.S.C. 1396r(i)(1)(A).