Montana nursing home responsiveness requirements

Montana's nursing facility licensure rule does not write its own standards — it requires every skilled nursing facility to comply with all of 42 CFR part 483, which is how the federal abuse/neglect reporting duty (and the rest of Part 483) becomes enforceable Montana licensure law.

A skilled nursing care facility shall comply with the Conditions of Participation for Skilled Nursing Facilities as set forth in 42 CFR subchapter G part 483. An intermediate care facility shall comply with the requirements set forth in 42 CFR subchapter G subpart I.

Independent of the federal rule, Montana statute gives every long-term care facility resident the right to be free from abuse, neglect and financial exploitation and directs facility staff to report suspected abuse to BOTH the department and the long-term care ombudsman.

A resident has the right to be free from verbal, mental, and physical abuse, neglect, or financial exploitation. Facility staff shall report to the department and the long-term care ombudsman any suspected incidents of abuse under the Montana Vulnerable Adult Prevention of Abuse Act, Title 52, chapter 3, part 8.

Montana's mandatory-reporter statute lists nurses, physicians, physician assistants, other health professionals and anyone employed by a nursing home among those who must report suspected abuse, sexual abuse, neglect or exploitation of a vulnerable adult, and routes reports about long-term care facility residents to the ombudsman and the department rather than to the county attorney in the first instance.

if the vulnerable adult is a resident of a long-term care facility, report the matter to the long-term care ombudsman appointed under the provisions of 42 U.S.C. 3027(a)(12) and to the department.

Montana has no free-standing state rule on physician availability or on-call coverage for nursing facilities; the 42 CFR 483.30 physician-services duty applies to Montana licensees only because ARM 37.106.601 adopts the whole of 42 CFR part 483 as the licensure standard.

A skilled nursing care facility shall comply with the Conditions of Participation for Skilled Nursing Facilities as set forth in 42 CFR subchapter G part 483.

Montana repealed its own nursing facility staffing rule — ARM 37.106.605, "Minimum Standards for a Skilled Nursing Care Facility for Each 24 Hour Period: Staffing," was repealed effective 9/24/2022 (2022 MAR p. 1876) — so licensed nurse coverage is now governed solely by 42 CFR 483.35 as incorporated by ARM 37.106.601, and no Montana rule separately requires an RN or physician to answer telephone calls.

A skilled nursing care facility shall comply with the Conditions of Participation for Skilled Nursing Facilities as set forth in 42 CFR subchapter G part 483.

Montana's Long-Term Health Care Facilities statute adopts the federal residents' rights by reference for ALL long-term care facilities (not just Medicare/Medicaid participants) and layers on state-specific rights including 30 days' notice of service or cost changes, resident advisory councils, grievance rights, prompt notice to the authorized representative of any significant change, 21 days' notice before involuntary transfer, and privacy in the resident's room.

The state adopts by reference for all long-term care facilities the rights for long-term care facility residents applied by the federal government to facilities that provide skilled nursing care or intermediate nursing care and participate in a medicaid or medicare program (42 U.S.C. 1395i-3(a) and 1396r(a), as implemented by regulation).

The facility administrator must adopt a written residents' rights statement covering at minimum the § 50-5-1104 rights, hand each resident a copy at admission against a signed acknowledgment, give written notice of any change, train staff on it, obtain each staff member's written affirmation that they have read it, and post it conspicuously for the public.

The administrator of the facility shall post in a conspicuous place visible to the public a copy of the facility's statement of residents' rights, presented in a format that can be read easily by the residents and by the public.

Every Montana skilled nursing facility must develop a written disaster plan jointly with other emergency services in the community, review or physically exercise it at least annually with a signed written report retained three years, and run at least four documented fire drills a year no closer than two months apart with at least one per shift.

skilled nursing facilities (long-term care), outpatient centers for primary care, outpatient centers for surgical services, critical access hospitals, hospitals, residential hospice facilities, inpatient hospice facilities, and infirmaries must develop a written disaster plan in conjunction with other emergency services in the community

Montana has no general nurse-call rule for ordinary resident rooms — its construction rule for all licensed health care facilities instead adopts by reference the 2018 AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities, NFPA 101 (2012 ed.) and ANSI A117.1 (2009), which are the standards in which resident call-system requirements sit, with 42 CFR 483.90 itself also reaching Montana facilities through ARM 37.106.601. Montana does write one call-system rule of its own: ARM 37.106.316(3)(e) and (4) require a secured care unit within a licensed long-term health care facility to have a nurse call system meeting AIA table 2.1-4, and that system must report to the secured care unit's own nurse station, though it may also annunciate the call at another location such as a main nurse station.

The construction of, alteration, or addition to a health care facility shall comply with: (a) the 2018 edition of the "American Institute for Architects (AIA) Guidelines for Design and Construction of Hospitals and Health Care Facilities," which the department adopts and incorporates by reference

Montana has no nursing-facility QAPI rule of its own — the 42 CFR 483.75 quality assurance and performance improvement duty binds Montana licensees only through ARM 37.106.601's blanket adoption of 42 CFR part 483.

A skilled nursing care facility shall comply with the Conditions of Participation for Skilled Nursing Facilities as set forth in 42 CFR subchapter G part 483.