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States should require that all beds in a nursing facility be certified for Medicaid and Medicare as a condition for the facility’s participation in Medicaid.

States should require adequate numbers of appropriately trained staff to ensure a high quality of care.

Quality measures: Participant preferences and satisfaction should be used as key quality measures.

Residential care settings is an umbrella term that refers to many types of certified and licensed housing plus services options.

The federal government should assume a much stronger role in ensuring the quality of services paid for by Medicaid in residential care settings.

Federal agencies should monitor the progress of state efforts in developing common definitions of, and minimum standards for, services and facilities in assisted living resi

Two government budget practices that can have significant implications for lower levels of government are block grants and unfunded mandates.

The Centers for Medicare & Medicaid Services, the states, and all other regulators should vigorously enforce all regulations in long-term services and supports (LTSS) facilities and home care w