Leavitt

FACTS AND PROCEDURAL HISTORY

I. Statutory Background

Congress enacted the Reform Law as part of the Omnibus Budget Reconciliation Act of 1987, Pub. L. No. 100-203, §§ 4201-4211, 101 Stat. 1330 (codified as amended at 42 U.S.C. §§ 1395i-3, 1396r). The Reform Law’s legislative his- tory indicates Congress was “deeply troubled that the Federal government, through the Medicaid program, continues to pay nursing facilities for providing poor quality care to vulnerable elderly and disabled beneficiaries.” H.R. Rep. No. 100-391(I) at 452 (1987). The “central purpose” of the Reform Law was “to improve the quality of care for Medicaid-eligible nursing home residents, and either to bring substandard facilities into compliance with Medicaid quality of care requirements or to exclude them from the program.” Id.

To effect this purpose, the Reform Law imposed several new requirements relating to nursing home1 resident services, including (1) an annual standardized resident assessment con- ducted by a registered nurse, 42 U.S.C. §§ 1395i-3(b)(3), 1396r(b)(3); (2) a written plan of care for each resident, id. §§ 1395i-3(b)(2), 1396r(b)(2); and (3) resident medical care under a physician’s…