What is the Law?

OBRA ’87 set the standard for all nursing homes when it comes to providing care and services to elderly residents. More specifically, this act also addresses the guidelines for dental services and makes each nursing home directly responsible for providing both routine and emergency dental services.

There are six dental service regulations that every nursing home should uphold:


Assist residents in obtaining routine and 24-hour emergency dental care.


Provide or obtain routine and emergency dental services by either hiring on staff or contracting with a dentist to meet the needs of each resident in a skilled nursing facility.


Charge (if desired) a Medicare resident (but not a Medicaid resident) an additional amount for routine, and again for emergency, dental services.


Provide or obtain from an outside resource emergency dental services as well as routine dental services (to the extent covered under the State Medicaid Plan) to meet the needs of Medicaid residents.


Assist the resident in making appointments and arranging for transportation to and from the dentist’s office.


Promptly refer a resident with lost or damaged dentures to a dentist.

Many states are trying to better uphold these regulations but numerous nursing homes fail every year to adequately maintain the oral health of their elderly residents.

Reference: Country Club Rehabilitation Campus – A Senior Health Care Community

The Omnibus Budget Reconciliation Act of 1987 (OBRA) and subsequent federal regulations established requirements for nursing facilities related to dental services and…oral health, of residents in those facilities. The appropriate treatment needs of residents must be met either by staff dentists or by dentists under contract with the facility to provide those services.

Reference: Journal of Dental Education September 1, 2005 vol. 69 no. 9 1015-1017

The first objective addresses the question, “Why should oral health services be provided in long-term care settings?” the wordings was carefully chosen to convey the need for preventive, routine, and emergency oral health care services as required by federal OBRA ’87 Medicare/Medicaid regulations. The phrase “…to preserve comfort , hygiene, and dignity” was chosen to emphasize that oral health care is basic supportive care that must always be maintained in long-term care.

Reference: SCD Special Care in Dentistry, Vol 16 No 4 1996

In the 20 years since the passage of OBRA 87, substantial progress has been made in providing improved quality care to nursing home residents, yet significant problems remain. Many of the problems identified prior to the passage of OBRA 87 still persist. The 20th anniversary of the nursing home reform amendments provides an important opportunity to consider lessons learned, assess options for the future, and establish strategies for caring for an aging population in a range of long-term care settings.


Nursing Home Quality Twenty Years After The Omnibus Budget Reconciliation Act of 1987

December 2007, The Henry J. Kaiser Family Foundation, Joshua M. Wiener, Ph.D. Marc P. Freiman, Ph.D. David Brown, M.A. RTI International