Legislation

The federal Omnibus Reconciliation Act of 1987 (OBRA) established some specific requirements for dental services in more than 20,000 nursing homes across the country. The Health Care Financing Administration (HCFA) mandated that all nursing homes receiving Medicaid and Medicare reimbursements provide routine and emergency oral health care to their residents.71 These regulations were effective on April 1, 1992 and specifically required long-term care facilities to 1) assist patients in obtaining routine and emergency dental care; 2) provide dental care internally or obtain this care from an external source for each resident; 3) assist in scheduling appointments for dental care and arrange transportation to the dentist; and 4) develop an oral health program that includes annual staff in-service training, an oral examination within 45 days of admission that is repeated annually for each resident, and a daily oral hygiene preventive care plan for each resident. Each facility should have an agreement with a dentist to deliver oral health care services and make referrals.72 Visits to the nursing home to assess residents’ needs and provide care can be accomplished bedside for the totally dependent patient or in an area designated for oral health care, with mobile equipment for those who are ambulatory (Figure 10).