101 STAT. 1330-186
PUBLIC LAW 100-203—DEC. 22, 1987 "(vi) routine dental services (to the extent covered under the State plan) and emergency dental services to meet the needs of each resident. The services provided or arranged by the facility must meet professional standards of quality. "(B)
QUALIFIED PERSONS PROVIDING SERVICES.—Services
described in clauses (i), (ii), (iii), (iv), and (vi) of subparagraph (A) must be provided by qualified persons in accordance with each resident's written plan of care. "(C) REQUIRED NURSING CARE; FACILITY WAIVERS.— "(i) GENERAL REQUIREMENTS.—With respect to
nursing facility services provided on or after October 1, 1990, a nursing facility— "(I) except as provided in clause (ii), must provide 24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents, and "(II) except as provided in clause (ii), must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week, "(ii) FACILITY WAIVERS.— "(i) WAIVER BY STATE.—A
State may waive the requirement of subclause (I) or (II) of clause (i) with respect to a facility if— "(I) the facility demonstrates to the satisfaction of the State that the facility has been unable, despite diligent efforts (including offering wages at the community prevailing rate for nursing facilities), to recruit appropriate personnel, "(II) the State determines that a waiver of the requirement will not endanger the health or safety of individuals staying in the facility, and "(III) the State finds that, for any such periods in which licensed nursing services are not available, a registered nurse or a physician is obligated to respond immediately to telephone calls from the facility. A waiver under this clause shall be subject to annual review and to the review of the Secretary and subject to clause (ii) shall be accepted by the Secretary for purposes of this title to the same extent as is the State's certification of the facility. In granting or renewing a waiver, a State may require the facility to employ other qualified, licensed personnel. "(ii)
ASSUMPTION OF WAIVER AUTHORITY BY SEC-
RETARY.—If the Secretary determines that a State has shown a clear pattern and practice of allowing waivers in the absence of diligent efforts by facilities to meet the staffing requirements, the Secretan^ shall assume and excercise the authority of the State to grant waivers. "(5) REQUIRED TRAINING OF NURSE AIDES.—
"(A) IN GENERAL.—A nursing facility must not use (on a full-time, temporary, per diem, or other basis) any individual, who is not a licensed health professional (as defined in subparagraph (E)), as a nurse aide in the facility on or after
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