LibGuides: Nursing Home and Assisted Living Laws: Federal and Ohio: Federal Laws

Introduction

If an individual spends three days in the hospital, and then requires skilled care, Medicare will pay for the care as follows:

• First 20 days—100% coverage as long as the individual is benefiting from the skilled care;

• Next 80 days—Individual pays first $185.50/day, Medicare picks up balance if the individual is benefiting from the skilled care;

• After 100 days—Medicare pays nothing.

More information about Medicare is available at my libguide, Medicare Law.

If you are low income, Medicaid will pay for nursing home care. See my libguide, Medicaid Law: Federal and Ohio.

26 U.S. Code § 213
Nursing home costs are tax deductible, if you itemize.
42 U.S. Code § 1395i–3
The Nursing Home Reform Act. Requirements for, and assuring quality of care in, skilled nursing facilities. Only the resident is liable for the cost of care in a nursing home.
42 U.S. Code § 1396p
Liens, adjustments and recoveries, and transfers of assets under Medicaid
42 U.S. Code § 1395pp
If a patient is not informed in advance and in writing that a provider believes Medicare will not cover the care provided, the patient may not be billed
42 U.S. Code § 1396r
Requirements for nursing facilities

42 CFR § 409.30
Basic requirements for medicare coverage of posthospital nursing home care.
42 CFR § 424.20
Requirements for posthospital nursing home care.
42 CFR § 483.10
Residents' rights.
42 CFR § 483.12
Freedom from abuse, neglect, and exploitation
42 CFR § 483.15
Admission, transfer, and discharge rights
42 CFR § 483.20
The facility must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity.
42 CFR § 488.430
Nursing home may be fined fined for infractions found at inspections.
42 CFR § 488.438
Fines may be up to $10,000 for infraction.

Talevski v. Health and Hospital Corporation of Marion County
2023. US Supreme Court reiterated that spending clause legislation gives rise to privately enforceable rights under 42 U.S.C. § 1983.