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A prime classic
When it comes to steak houses, Rae and Jerry's still a cut above
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Hey there, time traveller!
This article was published 17/04/2014 (3333 days ago), so information in it may no longer be current.
Back in 2009, rumour had it that Rae and Jerry's would be replaced by a Ruth's Chris steak house. Turns out it was only a rumour — there never were any negotiations. We still don't have a Ruth's Chris, and although trendoids may sneer, after almost 60 years this old-school institution endures, still holding its own in a sea of small plates, duck confits, truffle oil and pork bellies. It still packs them in, and if you try getting a seat without a reservation, you may end up eating in the lounge, which is not a bad thing, actually. It's popular — famous, even — the Winnipeg venue many out-of-town food writers have asked to see.
I've written about Rae and Jerry's before — snippets about brunch, about its $13.26 daily lunch bargains (Wednesday's pot roast is my eternal favourite), about a best-burger search — so it came as a surprise to realize I hadn't actually done a full column review in more years than I can remember.
Owner Steve Hrousalas, who has been there for 39 years, doesn't make the mistake of competing on somebody else's ground, and very little has changed over those years. Some think of it as a time warp of the '60s; some consider its unchanging decor of dark wood and red leatherette chairs dated. They miss the point. It isn't dated and it isn't retro either. It's the real deal — no kitsch, no doodads, just the solid, welcoming comfort of a classic steak house.
Families often have reunions here, because the menu has something for almost everybody. It's certainly been the case whenever my out-of-town relatives have descended en masse — the carnivores among us can sink their teeth into red meat, and the kosher among us can order fish. Fortunately there are no vegetarians in my clan, because their only choice would be a salad.
The menu is classic steak house, too. Calamari have been added to the appetizers (a bow, perhaps, to Hrousalas's roots), but I've suffered a surfeit of calamari lately, and opted instead for some of the long-term appetizers, which (in my mind, at least) are more typical of the genre. They were excellent and generous buys, at $5.75 each, on an otherwise fairly expensive menu — moist, tasty chopped liver and tangy pickled herring with sour cream, but I also couldn't resist the luxury of smoked salmon with onions, capers and cream cheese at a relatively moderate $12.75.
The steaks and prime rib cost from $34.25 for an eight-ounce New York cut to $41.25 for a 16-ounce rib steak. They aren't dry-aged, but they are hand-cut, perfectly prepared and very good. My personal preference is the prime rib roast, which I've always found to be the juiciest and most flavourful of the all the cuts. (Prices average $4 less at lunch).
Most of the beef dishes come with their natural juices only, but those who'd like some adornment should try the grenadine of beef — eight ounces of succulent sautéed tenderloin slices topped by mushrooms and onions. Those who'd like something to really gnaw on should have the meaty barbecued ribs in a tasty and not too goopy sauce ($33.25). And long before posher places caught on to it Rae and Jerry's always had fresh fish on the menu — salmon, pickerel or halibut — and our simply grilled pickerel was excellent ($33.25).
As often as not, the meat I succumb to is the spectacular sautéed liver ($32.75). I've had good beef liver in other restaurants, but nowhere else have I found calves' liver — from Provimi veal, in this case, pale, tender, moist and as good as liver gets. It comes in a gargantuan portion, garnished with bacon and also, if wished (although the menu doesn't mention it), sautéed onions.
Dinners still start with a basketful of irresistible breads from City Bread (they are particularly generous with the butter, too) and include a choice of tomato juice or soup. But although the mains were uniformly delicious, the included extras were inconsistent. One night's thick split pea soup, with wee bits of ham, was hearty and delicious, but another night's vegetable soup tasted mainly of undercooked flour.
The skinny fries are sensational, but the mashed potatoes, although tasty on one visit, needed more salt on another, and were dry and lukewarm on both. The onion salad has never disappointed; the coleslaw has ranged from bland to good; and the daily veggies — our steamed spinach and green beans — were unexceptional but OK..
The desserts are all house-made, far more numerous than they used to be, and better. Among them are a smooth, light cheesecake with black cherries; a lovely light and refreshing key lime pie; and a luscious coconut cream pie with white chocolate shavings and a drizzle of chocolate sauce ($7.25 each).
The wine list is also longer and better than it used to be, with 26 by the glass, but Rae and Jerry's usually means cocktails to me, and my tipple, a bloody caesar — was perfect.
Service was also perfect — attentive, knowledgeable and really nice. And I'd like to add just one more significant detail: unlike many upscale establishments, where a pepper grinder is offered before you've even tasted your food and rarely ever again, every table at Rae and Jerry's sports a pepper grinder — a very handsome one at that.
Updated on Thursday, April 17, 2014 6:30 AM CDT: Updates map


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In solidarity with Mitko, a 17 year old boy who was severely beaten in Bulgaria for saying that Roma are equal to non-Roma, Romani people and non-Roma alike are sharing pictures with the #RomaAreEqual. Let's show Mitko that he's not alone, and show the haters that Roma Rise Up. Opre Roma!
For those of you in NYC this weekend, be sure to come to the Romani Arts Conference at NYU! It's free to the public! And at the end, there will be a concert by one of the world's best Romani singers, Esme Redzepova! If you're not in the city, never fear. It will be live streamed.

subset: commoncrawl


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Comments by the Chairman of the Judges Satkar Gidda
The design awards entries are truly a creative wonderland. To be able to think freely and create something without the constraint of a production line must be a designers dream.
And, as before, the entries were very inventive in the student category. As judges, we often think of the possible thought process that the designer may have gone through to create the piece of work but in the end we view it independently and determine what the 'wow' factor is.
Designs don't have to be complex to create this 'wow' effect. In fact some of the entries were so brilliant because they were simple. It had us thinking 'why didn't anyone else think of that before'.
As can be seen by the winning and highly commended entries, these products were not just about packaging.
As Richard has pointed out, Judging did take longer than normal but that is a good thing. It means that there were a lot of great entries for the judges to consider.
The thumb plate was just a wonderful idea. So simple yet so practical. The wrap bag too is a great idea, well executed. We particularly like the additional promotional space that was available for communication when the bag is opened.
Those entries that were highly commended were not far behind the winners and are fully worthy of their position on the shortlist. My congratulations to all the entrants.
Satkar Gidda
London September 2008
Satkar Gidda studied Business Studies and Marketing and has worked 6 years in Sales, Trade Marketing and Brand Marketing for RHM Foods and Nestle followed by 30 years as Sales & Marketing Director of SiebertHead, the longest established brand and packaging design consultancy in the UK. Since March 2020, Satkar operates as an independent consultant.
Guido Brosius
has been working in the packaging business for more than 30 years. He started his career as Packaging Designer for GB and went on to become Packaging Manager for Carrefour Belgium, part of the Carrefour Group, the world's 2nd biggest retailer and number 1 in Europe. Carrefour Belgium has a 25% market share and almost 600 stores making it market leader in Belgium.
Guido has built up extensive experience in packaging design, marketing and graphic procedures via the retail sector and is an expert in packaging materials and ecological aspects. In recent years he has also been very active in the bio-packaging sector and he won the BBP 2007 Award (Belgian Bio Packaging) for the initiatives he implemented at Carrefour Belgium.
Martin Luh
studied Repro and Printing Technology in Vienna. He started his career in the packaging industry and worked for the former Alfred Wall AG (now Mead Westvaco) and later for Mayr-Melnhof Packaging in Sales and Customer Service. In 1996 Martin joined Nestlé Austria where he managed packaging purchasing activities as well as inter-company supply. Since 2004 he has been working as Category Manager for European Procurement at Nestlé where he is presently responsible for strategic sourcing of cartonboard and paper. This role also involves global supplier profiling and relationship management as well as business support for material selection and new product development.
John de Somer
started in 1989 working for Sirius Graphics as price analyst, sales manager and finally sales director. In 1993 he became Director of Van Genechten and marketing manager of Van Genechten Packaging. Since 2002 he has been President of Pro Carton Belgium and a member of the Executive of Pro Carton International. VGP is a private group of 9 folding carton plants in 6 countries, servicing the European FMCG industry with board and micro flute packaging and packaging systems from high volumes cartons for the mass market to highly sophisticated boxes for the premium markets in luxury drinks, confectionery and cosmetics.
Ian Bates
is the founder and co owner of Portabrands, a company that designs, develops and brings new packaging ideas to market. It operates especially in the carry out drinks markets in such sectors as wine, beer and coffee and since 2004 Ian has brought many new innovative designs and ideas to the industry.
With a background in paper and packaging with such companies as M-real, Assi Doman and David S Smith his 20 plus years in the packaging industry brings a wealth of experience and a passion to use the most environmentally sustainable materials in all his designs.


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Sec. 1819. [42 U.S.C. 1395i–3] (a) Skilled Nursing Facility Defined.—In this title, the term "skilled nursing facility" means an institution (or a distinct part of an institution) which—
(1) is primarily engaged in providing to residents—
(A) skilled nursing care and related services for residents who require medical or nursing care, or
(B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons,
and is not primarily for the care and treatment of mental diseases;
(2) has in effect a transfer agreement (meeting the requirements of section 1861(l)) with one or more hospitals having agreements in effect under section 1866; and
(3) meets the requirements for a skilled nursing facility described in subsections (b), (c), and (d) of this section.
(b) Requirements Relating to Provision of Services.—
(1) Quality of life.—
(A) In general.—A skilled nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.
(B) Quality assessment and assurance.—A skilled nursing facility must maintain a quality assessment and assurance committee, consisting of the director of nursing services, a physician designated by the facility, and at least 3 other members of the facility's staff, which (i) meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary and (ii) develops and implements appropriate plans of action to correct identified quality deficiencies. A State or the Secretary may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this subparagraph.
(2) Scope of services and activities under plan of care.—A skilled nursing facility must provide services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, in accordance with a written plan of care which—
(A) describes the medical, nursing, and psychosocial needs of the resident and how such needs will be met;
(B) is initially prepared, with the participation to the extent practicable of the resident or the resident's family or legal representative, by a team which includes the resident's attending physician and a registered professional nurse with responsibility for the resident; and
(C) is periodically reviewed and revised by such team after each assessment under paragraph (3).
(3) Residents' assessment.—
(A) Requirement.—A skilled nursing facility must conduct a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity, which assessment—
(i) describes the resident's capability to perform daily life functions and significant impairments in functional capacity;
(ii) is based on a uniform minimum data set specified by the Secretary under subsection (f)(6)(A);
(iii) uses an instrument which is specified by the State under subsection (e)(5); and
(iv) includes the identification of medical problems.
(B) Certification.—
(i) In general.—Each such assessment must be conducted or coordinated (with the appropriate participation of health professionals) by a registered professional nurse who signs and certifies the completion of the assessment. Each individual who completes a portion of such an assessment shall sign and certify as to the accuracy of that portion of the assessment.
(ii) Penalty for falsification.—
(I) An individual who willfully and knowingly certifies under clause (i) a material and false statement in a resident assessment is subject to a civil money penalty of not more than $1,000 with respect to each assessment.
(II) An individual who willfully and knowingly causes another individual to certify under clause (i) a material and false statement in a resident assessment is subject to a civil money penalty of not more than $5,000 with respect to each assessment.
(III) The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
(iii) Use of independent assessors.—If a State determines, under a survey under subsection (g) or otherwise, that there has been a knowing and willful certification of false assessments under this paragraph, the State may require (for a period specified by the State) that resident assessments under this paragraph be conducted and certified by individuals who are independent of the facility and who are approved by the State.
(C) Frequency.—
(i) In general.—Subject to the timeframes prescribed by the Secretary under section 1888(e)(6), such an assessment must be conducted—
(I) promptly upon (but no later than 14 days after the date of) admission for each individual admitted on or after October 1, 1990, and by not later than January 1, 1991, for each resident of the facility on that date;
(II) promptly after a significant change in the resident's physical or mental condition; and
(III) in no case less often than once every 12 months.
(ii) Resident review.—The skilled nursing facility must examine each resident no less frequently than once every 3 months and, as appropriate, revise the resident's assessment to assure the continuing accuracy of the assessment.
(D) Use.—The results of such an assessment shall be used in developing, reviewing, and revising the resident's plan of care under paragraph (2).
(E) Coordination.—Such assessments shall be coordinated with any State-required preadmission screening program to the maximum extent practicable in order to avoid duplicative testing and effort.
(4) Provision of services and activities.—
(A)[59] In general.—To the extent needed to fulfill all plans of care described in paragraph (2), a skilled nursing facility must provide, directly or under arrangements (or, with respect to dental services, under agreements) with others for the provision of—
(i) nursing services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident;
(ii) medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident;
(iii) pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident;
(iv) dietary services that assure that the meals meet the daily nutritional and special dietary needs of each resident;
(v) an on-going program, directed by a qualified professional, of activities designed to meet the interests and the physical, mental, and psychosocial well-being of each resident;
(vi) routine and emergency dental services to meet the needs of each resident; and
(vii) treatment and services required by mentally ill and mentally retarded residents not otherwise provided or arranged for (or required to be provided or arranged for) by the State.
The services provided or arranged by the facility must meet professional standards of quality. Nothing in clause (vi) shall be construed as requiring a facility to provide or arrange for dental services described in that clause without additional charge.
(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.—
(i) In general.—Except as provided in clause (ii), a skilled nursing facility must provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, 7 days a week.
(ii) Exception.—To the extent that clause (i) may be deemed to require that a skilled nursing facility engage the services of a registered professional nurse for more than 40 hours a week, the Secretary is authorized to waive such requirement if the Secretary finds that—
(I) the facility is located in a rural area and the supply of skilled nursing facility services in such area is not sufficient to meet the needs of individuals residing therein,
(II) the facility has one full-time registered professional nurse who is regularly on duty at such facility 40 hours a week,
(III) the facility either has only patients whose physicians have indicated (through physicians' orders or admission notes) that each such patient does not require the services of a registered nurse or a physician for a 48-hour period, or has made arrangements for a registered professional nurse or a physician to spend such time at such facility as may be indicated as necessary by the physician to provide necessary skilled nursing services on days when the regular full-time registered professional nurse is not on duty,
(IV) the Secretary provides notice of the waiver to the State long-term care ombudsman (established under section 307(a)(12) of the Older Americans Act of 1965[60]) and the protection and advocacy system in the State for the mentally ill and the mentally retarded, and
(V) the facility that is granted such a waiver notifies residents of the facility (or, where appropriate, the guardians or legal representatives of such residents) and members of their immediate families of the waiver.
A waiver under this subparagraph shall be subject to annual renewal.
(5) Required training of nurse aides.—
(A) In general.—
(i) Except as provided in clause (ii), a skilled nursing facility must not use on a full-time basis any individual as a nurse aide in the facility on or after October 1, 1990 for more than 4 months unless the individual—
(I) has completed a training and competency evaluation program, or a competency evaluation program, approved by the State under subsection (e)(1)(A), and
(II) is competent to provide nursing or nursing-related services.
(ii) A skilled nursing facility must not use on a temporary, per diem, leased, or on any basis other than as a permanent employee any individual as a nurse aide in the facility on or after January 1, 1991, unless the individual meets the requirements described in clause (i).
(B) Offering competency evaluation programs for current employees.—A skilled nursing facility must provide, for individuals used as a nurse aide by the facility as of January 1, 1990, for a competency evaluation program approved by the State under subsection (e)(1) and such preparation as may be necessary for the individual to complete such a program by October 1, 1990.
(C) Competency.—The skilled nursing facility must not permit an individual, other than in a training and competency evaluation program approved by the State, to serve as a nurse aide or provide services of a type for which the individual has not demonstrated competency and must not use such an individual as a nurse aide unless the facility has inquired of any State registry established under subsection (e)(2)(A) that the facility believes will include information concerning the individual.
(D) Re-training required.—For purposes of subparagraph (A), if, since an individual's most recent completion of a training and competency evaluation program, there has been a continuous period of 24 consecutive months during none of which the individual performed nursing or nursing-related services for monetary compensation, such individual shall complete a new training and competency evaluation program or a new competency evaluation program.
(E) Regular in-service education.—The skilled nursing facility must provide such regular performance review and regular in-service education as assures that individuals used as nurse aides are competent to perform services as nurse aides, including training for individuals providing nursing and nursing-related services to residents with cognitive impairments.
(F) Nurse aide defined.—In this paragraph, the term "nurse aide" means any individual providing nursing or nursing-related services to residents in a skilled nursing facility, but does not include an individual—
(i) who is a licensed health professional (as defined in subparagraph (G)) or a registered dietician, or
(ii) who volunteers to provide such services without monetary compensation.
Such term includes an individual who provides such services through an agency or under a contract with the facility.
(G) Licensed health professional defined.—In this paragraph, the term "licensed health professional" means a physician, physician assistant, nurse practitioner, physical, speech, or occupational therapist, physical or occupational therapy assistant, registered professional nurse, licensed practical nurse, or licensed certified social worker, registered respiratory therapist, or certified respiratory therapy technician.
(6) Physician supervision and clinical records.—A skilled nursing facility must—
(A) require that the medical care of every resident be provided under the supervision of a physician;
(B) provide for having a physician available to furnish necessary medical care in case of emergency; and
(C) maintain clinical records on all residents, which records include the plans of care (described in paragraph (2)) and the residents' assessments (described in paragraph (3)).
(7) Required social services.—In the case of a skilled nursing facility with more than 120 beds, the facility must have at least one social worker (with at least a bachelor's degree in social work or similar professional qualifications) employed full-time to provide or assure the provision of social services.
(8) Information on nurse staffing.—
(A) In general.—A skilled nursing facility shall post daily for each shift the current number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. The information shall be displayed in a uniform manner (as specified by the Secretary) and in a clearly visible place.
(B) Publication of data.—A skilled nursing facility shall, upon request, make available to the public the nursing staff data described in subparagraph (A).
(c) Requirements Relating to Residents' Rights.—
(1) General rights.—
(A) Specified rights.—A skilled nursing facility must protect and promote the rights of each resident, including each of the following rights:
(i) Free choice.—The right to choose a personal attending physician, to be fully informed in advance about care and treatment, to be fully informed in advance of any changes in care or treatment that may affect the resident's well-being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment.
(ii) Free from restraints.—The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. Restraints may only be imposed—
(I) to ensure the physical safety of the resident or other residents, and
(II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used (except in emergency circumstances specified by the Secretary until such an order could reasonably be obtained).
(iii) Privacy.—The right to privacy with regard to accommodations, medical treatment, written and telephonic communications, visits, and meetings of family and of resident groups.
(iv) Confidentiality.—The right to confidentiality of personal and clinical records and to access to current clinical records of the resident upon request by the resident or the resident's legal representative, within 24 hours (excluding hours occurring during a weekend or holiday) after making such a request.
(v) Accommodation of needs.—The right—
(I) to reside and receive services with reasonable accommodation of individual needs and preferences, except where the health or safety of the individual or other residents would be endangered, and
(II) to receive notice before the room or roommate of the resident in the facility is changed.
(vi) Grievances.—The right to voice grievances with respect to treatment or care that is (or fails to be) furnished, without discrimination or reprisal for voicing the grievances and the right to prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.
(vii) Participation in resident and family groups.—The right of the resident to organize and participate in resident groups in the facility and the right of the resident's family to meet in the facility with the families of other residents in the facility.
(viii) Participation in other activities.—The right of the resident to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.
(ix) Examination of survey results.—The right to examine, upon reasonable request, the results of the most recent survey of the facility conducted by the Secretary or a State with respect to the facility and any plan of correction in effect with respect to the facility.
(x) Refusal of certain transfers.—The right to refuse a transfer to another room within the facility, if a purpose of the transfer is to relocate the resident from a portion of the facility that is a skilled nursing facility (for purposes of this title) to a portion of the facility that is not such a skilled nursing facility.
(xi) Other rights.—Any other right established by the Secretary.
Clause (iii) shall not be construed as requiring the provision of a private room. A resident's exercise of a right to refuse transfer under clause (x) shall not affect the resident's eligibility or entitlement to benefits under this title or to medical assistance under title XIX of this Act.
(B) Notice of rights and services.—A skilled nursing facility must—
(i) inform each resident, orally and in writing at the time of admission to the facility, of the resident's legal rights during the stay at the facility;
(ii) make available to each resident, upon reasonable request, a written statement of such rights (which statement is updated upon changes in such rights) including the notice (if any) of the State developed under section 1919(e)(6); and
(iii) inform each other resident, in writing before or at the time of admission and periodically during the resident's stay, of services available in the facility and of related charges for such services, including any charges for services not covered under this title or by the facility's basic per diem charge.
The written description of legal rights under this subparagraph shall include a description of the protection of personal funds under paragraph (6) and a statement that a resident may file a complaint with a State survey and certification agency respecting resident abuse and neglect and misappropriation of resident property in the facility.
(C) Rights of incompetent residents.—In the case of a resident adjudged incompetent under the laws of a State, the rights of the resident under this title shall devolve upon, and, to the extent judged necessary by a court of competent jurisdiction, be exercised by, the person appointed under State law to act on the resident's behalf.
(D) Use of Psychopharmacologic Drugs.—Psychopharmacologic drugs may be administered only on the orders of a physician and only as part of a plan (included in the written plan of care described in paragraph (2)) designed to eliminate or modify the symptoms for which the drugs are prescribed and only if, at least annually, an independent, external consultant reviews the appropriateness of the drug plan of each resident receiving such drugs. In determining whether such a consultant is qualified to conduct reviews under the preceding sentence, the Secretary shall take into account the needs of nursing facilities under this title to have access to the services of such a consultant on a timely basis.
(E) Information respecting advance directives.—A skilled nursing facility must comply with the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives).
(2) Transfer and discharge rights.—
(A) In general.—A skilled nursing facility must permit each resident to remain in the facility and must not transfer or discharge the resident from the facility unless—
(i) the transfer or discharge is necessary to meet the resident's welfare and the resident's welfare cannot be met in the facility;
(ii) the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;
(iii) the safety of individuals in the facility is endangered;
(iv) the health of individuals in the facility would otherwise be endangered;
(v) the resident has failed, after reasonable and appropriate notice, to pay (or to have paid under this title or title XIX on the resident's behalf) for a stay at the facility; or
(vi) the facility ceases to operate.
In each of the cases described in clauses (i) through (v), the basis for the transfer or discharge must be documented in the resident's clinical record. In the cases described in clauses (i) and (ii), the documentation must be made by the resident's physician, and in the cases described in clauses (iii) and (iv) the documentation must be made by a physician.
(B) Pre-transfer and pre-discharge notice.—
(i) In general.—Before effecting a transfer or discharge of a resident, a skilled nursing facility must—
(I) notify the resident (and, if known, a family member of the resident or legal representative) of the transfer or discharge and the reasons therefor,
(II) record the reasons in the resident's clinical record (including any documentation required under subparagraph (A)), and
(III) include in the notice the items described in clause (iii).
(ii) Timing of notice.—The notice under clause (i)(I) must be made at least 30 days in advance of the resident's transfer or discharge except—
(I) in a case described in clause (iii) or (iv) of subparagraph (A);
(II) in a case described in clause (ii) of subparagraph (A), where the resident's health improves sufficiently to allow a more immediate transfer or discharge;
(III) in a case described in clause (i) of subparagraph (A), where a more immediate transfer or discharge is necessitated by the resident's urgent medical needs; or
(IV) in a case where a resident has not resided in the facility for 30 days.
In the case of such exceptions, notice must be given as many days before the date of the transfer or discharge as is practicable.
(iii) Items included in notice.—Each notice under clause (i) must include—
(I) for transfers or discharges effected on or after October 1, 1990, notice of the resident's right to appeal the transfer or discharge under the State process established under subsection (e)(3); and
(II) the name, mailing address, and telephone number of the State long-term care ombudsman (established under title III or VII of the Older Americans Act of 1965[61] in accordance with section 712 of the Act).
(C) Orientation.—A skilled nursing facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.
(3) Access and visitation rights.—A skilled nursing facility must—
(A) permit immediate access to any resident by any representative of the Secretary, by any representative of the State, by an ombudsman described in paragraph (2)(B)(iii)(II), or by the resident's individual physician;
(B) permit immediate access to a resident, subject to the resident's right to deny or withdraw consent at any time, by immediate family or other relatives of the resident;
(C) permit immediate access to a resident, subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, by others who are visiting with the consent of the resident;
(D) permit reasonable access to a resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time; and
(E) permit representatives of the State ombudsman (described in paragraph (2)(B)(iii)(II)), with the permission of the resident (or the resident's legal representative) and consistent with State law, to examine a resident's clinical records.
(4) Equal access to quality care.—A skilled nursing facility must establish and maintain identical policies and practices regarding transfer, discharge, and covered services under this title for all individuals regardless of source of payment.
(5) Admissions Policy.—
(A) Admissions.—With respect to admissions practices, a skilled nursing facility must—
(i)(I) not require individuals applying to reside or residing in the facility to waive their rights to benefits under this title or under a State plan under title XIX, (II) not require oral or written assurance that such individuals are not eligible for, or will not apply for, benefits under this title or such a State plan, and (III) prominently display in the facility and provide to such individuals written information about how to apply for and use such benefits and how to receive refunds for previous payments covered by such benefits; and
(ii) not require a third party guarantee of payment to the facility as a condition of admission (or expedited admission) to, or continued stay in, the facility.
(B) Construction.—
(i) No preemption of stricter standards.—Subparagraph (A) shall not be construed as preventing States or political subdivisions therein from prohibiting, under State or local law, the discrimination against individuals who are entitled to medical assistance under this title with respect to admissions practices of skilled nursing facilities.
(ii) Contracts with legal representatives.—Subparagraph (A)(ii) shall not be construed as preventing a facility from requiring an individual, who has legal access to a resident's income or resources available to pay for care in the facility, to sign a contract (without incurring personal financial liability) to provide payment from the resident's income or resources for such care.
(6) Protection of resident funds.—
(A) In general.—The skilled nursing facility—
(i) may not require residents to deposit their personal funds with the facility, and
(ii) upon the written authorization of the resident, must hold, safeguard, and account for such personal funds under a system established and maintained by the facility in accordance with this paragraph.
(B) Management of personal funds.—Upon written authorization of a resident under subparagraph (A)(ii), the facility must manage and account for the personal funds of the resident deposited with the facility as follows:
(i) Deposit.—The facility must deposit any amount of personal funds in excess of $100 with respect to a resident in an interest bearing account (or accounts) that is separate from any of the facility's operating accounts and credits all interest earned on such separate account to such account. With respect to any other personal funds, the facility must maintain such funds in a non-interest bearing account or petty cash fund.
(ii) Accounting and records.—The facility must assure a full and complete separate accounting of each such resident's personal funds, maintain a written record of all financial transactions involving the personal funds of a resident deposited with the facility, and afford the resident (or a legal representative of the resident) reasonable access to such record.
(iii) Conveyance upon death.—Upon the death of a resident with such an account, the facility must convey promptly the resident's personal funds (and a final accounting of such funds) to the individual administering the resident's estate.
(C) Assurance of financial security.—The facility must purchase a surety bond, or otherwise provide assurance satisfactory to the Secretary, to assure the security of all personal funds of residents deposited with the facility.
(D) Limitation on charges to personal funds.—The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under this title or title XIX.
(d) Requirements Relating to Administration and Other Matters.—
(1) Administration.—
(A) In general.—A skilled nursing facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident (consistent with requirements established under subsection (f)(5)).
(B)[62] Required notices.—If a change occurs in—
(i) the persons with an ownership or control interest (as defined in section 1124(a)(3)) in the facility
(ii) the persons who are officers, directors, agents, or managing employees (as defined in section 1126(b)) of the facility
(iii) the corporation, association, or other company responsible for the management of the facility, or
(iv) the individual who is the administrator or director of nursing of the facility,
(C) Skilled nursing facility administrator.—The administrator of a skilled nursing facility must meet standards established by the Secretary under subsection (f)(4).
(C)[63] Availability of survey, certification, and complaint investigation reports.—A skilled nursing facility must—
(i) have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
(ii) post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
The facility shall not make available under clause (i) identifying information about complainants or residents.
(2) Licensing and life safety code.—
(A) Licensing.—A skilled nursing facility must be licensed under applicable State and local law.
(B) Life safety code.—A skilled nursing facility must meet such provisions of such edition (as specified by the Secretary in regulation) of the Life Safety Code of the National Fire Protection Association as are applicable to nursing homes; except that—
(i) the Secretary may waive, for such periods as he deems appropriate, specific provisions of such Code which if rigidly applied would result in unreasonable hardship upon a facility, but only if such waiver would not adversely affect the health and safety of residents or personnel, and
(ii) the provisions of such Code shall not apply in any State if the Secretary finds that in such State there is in effect a fire and safety code, imposed by State law, which adequately protects residents of and personnel in skilled nursing facilities.
(3) Sanitary and infection control and physical environment.—A skilled nursing facility must—
(A) establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment in which residents reside and to help prevent the development and transmission of disease and infection, and
(B) be designed, constructed, equipped, and maintained in a manner to protect the health and safety of residents, personnel, and the general public.
(4) Miscellaneous.—
(A) Compliance with federal, state, and local laws and professional standards.—A skilled nursing facility must operate and provide services in compliance with all applicable Federal, State, and local laws and regulations (including the requirements of section 1124) and with accepted professional standards and principles which apply to professionals providing services in such a facility.
(B) Other.—A skilled nursing facility must meet such other requirements relating to the health, safety, and well-being of residents or relating to the physical facilities thereof as the Secretary may find necessary.
(e) State Requirements Relating to Skilled Nursing Facility Requirements.—The requirements, referred to in section 1864(d), with respect to a State are as follows:
(1) Specification and review of nurse aide training and competency evaluation programs and of nurse aide competency evaluation programs.—The State must—
(A) by not later than January 1, 1989, specify those training and competency evaluation programs, and those competency evaluation programs, that the State approves for purposes of subsection (b)(5) and that meet the requirements established under subsection (f)(2), and
(B) by not later than January 1, 1990, provide for the review and reapproval of such programs, at a frequency and using a methodology consistent with the requirements established under subsection (f)(2)(A)(iii).
The failure of the Secretary to establish requirements under subsection (f)(2) shall not relieve any State of its responsibility under this paragraph.
(2) Nurse aide registry.—
(A) In general.—By not later than January 1, 1989, the State shall establish and maintain a registry of all individuals who have satisfactorily completed a nurse aide training and competency evaluation program, or a nurse aide competency evaluation program, approved under paragraph (1) in the State, or any individual described in subsection (f)(2)(B)(ii) or in subparagraph (B), (C), or (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989.
(B) Information in registry.—The registry under subparagraph (A) shall provide (in accordance with regulations of the Secretary) for the inclusion of specific documented findings by a State under subsection (g)(1)(C) of resident neglect or abuse or misappropriation of resident property involving an individual listed in the registry, as well as any brief statement of the individual disputing the findings, but shall not include any allegations of resident abuse or neglect or misappropriation of resident property that are not specifically documented by the State under such subsection. The State shall make available to the public information in the registry. In the case of inquiries to the registry concerning an individual listed in the registry, any information disclosed concerning such a finding shall also include disclosure of any such statement in the registry relating to the finding or a clear and accurate summary of such a statement.
(C) Prohibition against charges.—A State may not impose any charges on a nurse aide relating to the registry established and maintained under subparagraph (A).
(3) State appeals process for transfers and discharges.—The State, for transfers and discharges from skilled nursing facilities effected on or after October 1, 1989, must provide for a fair mechanism for hearing appeals on transfers and discharges of residents of such facilities. Such mechanism must meet the guidelines established by the Secretary under subsection (f)(3); but the failure of the Secretary to establish such guidelines shall not relieve any State of its responsibility to provide for such a fair mechanism.
(4) Skilled nursing facility administrator standards.—By not later than January 1, 1990, the State must have implemented and enforced the skilled nursing facility administrator standards developed under subsection (f)(4) respecting the qualification of administrators of skilled nursing facilities.
(5) Specification of resident assessment instrument.—Effective July 1, 1990, the State shall specify the instrument to be used by nursing facilities in the State in complying with the requirement of subsection (b)(3)(A)(iii). Such instrument shall be—
(A) one of the instruments designated under subsection (f)(6)(B), or
(B) an instrument which the Secretary has approved as being consistent with the minimum data set of core elements, common definitions, and utilization guidelines specified by the Secretary under subsection (f)(6)(A).
(f) Responsibilities of Secretary Relating to Skilled Nursing Facility Requirements.—
(1) General responsibility.—It is the duty and responsibility of the Secretary to assure that requirements which govern the provision of care in skilled nursing facilities under this title, and the enforcement of such requirements, are adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient use of public moneys.
(2) Requirements for nurse aide training and competency evaluation programs and for nurse aide competency evaluation programs.—
(A) In general.—For purposes of subsections (b)(5) and (e)(1)(A), the Secretary shall establish, by not later than September 1, 1988—
(i) requirements for the approval of nurse aide training and competency evaluation programs, including requirements relating to (I) the areas to be covered in such a program (including at least basic nursing skills, personal care skills, recognition of mental health and social service needs, care of cognitively impaired residents, basic restorative services, and residents' rights) and content of the curriculum (including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training, and patient abuse prevention training[64], (II) minimum hours of initial and ongoing training and retraining (including not less than 75 hours in the case of initial training), (III) qualifications of instructors, and (IV) procedures for determination of competency;
(ii) requirements for the approval of nurse aide competency evaluation programs, including requirement relating to the areas to be covered in such a program, including at least basic nursing skills, personal care skills, recognition of mental health and social service needs, care of cognitively impaired residents, basic restorative services, residents' rights, and procedures for determination of competency;
(iii) requirements respecting the minimum frequency and methodology to be used by a State in reviewing such programs' compliance with the requirements for such programs; and
(iv) requirements, under both such programs, that—
(I) provide procedures for determining competency that permit a nurse aide, at the nurse aide's option, to establish competency through procedures or methods other than the passing of a written examination and to have the competency evaluation conducted at the nursing facility at which the aide is (or will be) employed (unless the facility is described in subparagraph (B)(iii)(I)),
(II) prohibit the imposition on a nurse aide who is employed by (or who has received an offer of employment from) a facility on the date on which the aide begins either such program of any charges (including any charges for textbooks and other required course materials and any charges for the competency evaluation) for either such program, and
(III) in the case of a nurse aide not described in subclause (II) who is employed by (or who has received an offer of employment from) a facility not later than 12 months after completing either such program, the State shall provide for the reimbursement of costs incurred in completing such program on a prorata basis during the period in which the nurse aide is so employed.
(B) Approval of certain programs.—Such requirements—
(i) may permit approval of programs offered by or in facilities, as well as outside facilities (subject to clause (iii)), (including employee organizations), and of programs in effect on the date of the enactment of this section[65];
(ii) shall permit a State to find that an individual who has completed (before July 1, 1989) a nurse aide training and competency evaluation program shall be deemed to have completed such a program approved under subsection (b)(5) if the State determines that, at the time the program was offered, the program met the requirements for approval under such paragraph; and
(iii) subject to subparagraphs (C) and (D), shall prohibit approval of such a program—
(I) offered by or in a skilled nursing facility which, within the previous 2 years—
(a) has operated under a waiver under subsection (b)(4)(C)(ii)(II);
(b) has been subject to an extended (or partial extended) survey under subsection (g)(2)(B)(i) or section 1919(g)(2)(B)(i), unless the survey shows that the facility is in compliance with the requirements of subsections (b), (c), and (d) of this section; or
(c) has been assessed a civil money penalty described in subsection (h)(2)(B)(ii) or section 1919(h)(2)(A)(ii) of not less than $5,000, or has been subject to a remedy described in clause (i) or (iii) of subsection (h)(2)(B), subsection (h)(4), section 1919(h)(1)(B)(i), or in clause (i), (iii), or (iv) of section 1919(h)(2)(A), or
(II) offered by or in a skilled nursing facility unless the State makes the determination, upon an individual's completion of the program, that the individual is competent to provide nursing and nursing-related services in skilled nursing facilities.
A State may not delegate (through subcontract or otherwise) its responsibility under clause (iii)(II) to the skilled nursing facility.
(C) Waiver authorized.—Clause (iii)(I) of subparagraph (B) shall not apply to a program offered in (but not by) a nursing facility (or skilled nursing facility for purposes of title XVIII) in a State if the State—
(i) determines that there is no other such program offered within a reasonable distance of the facility,
(ii) assures, through an oversight effort, that an adequate environment exists for operating the program in the facility, and
(iii) provides notice of such determination and assurances to the State long–term care ombudsman.
(D) Waiver of disapproval of nurse-aide training programs.—Upon application of a nursing facility, the Secretary may waive the application of subparagraph (B)(iii)(I)(c) if the imposition of the civil monetary penalty was not related to the quality of care provided to residents of the facility. Nothing in this subparagraph shall be construed as eliminating any requirement upon a facility to pay a civil monetary penalty described in the preceding sentence.
(3) Federal guidelines for state appeals process for transfers and discharges.—For purposes of subsections (c)(2)(B)(iii)(I) and (e)(3), by not later than October 1, 1988, the Secretary shall establish guidelines for minimum standards which State appeals processes under subsection (e)(3) must meet to provide a fair mechanism for hearing appeals on transfers and discharges of residents from skilled nursing facilities.
(4) Secretarial standards for qualification of administrators.—For purposes of subsections (d)(1)(C) and (e)(4), the Secretary shall develop, by not later than March 1, 1989, standards to be applied in assuring the qualifications of administrators of skilled nursing facilities.
(5) Criteria for administration.—The Secretary shall establish criteria for assessing a skilled nursing facility's compliance with the requirement of subsection (d)(1) with respect to—
(A) its governing body and management,
(B) agreements with hospitals regarding transfers of residents to and from the hospitals and to and from other skilled nursing facilities,
(C) disaster preparedness,
(D) direction of medical care by a physician,
(E) laboratory and radiological services,
(F) clinical records, and
(G) resident and advocate participation.
(6) Specification of resident assessment data set and instruments.—The Secretary shall—
(A) not later than January 1, 1989, specify a minimum data set of core elements and common definitions for use by nursing facilities in conducting the assessments required under subsection (b)(3), and establish guidelines for utilization of the data set; and
(B) by not later than April 1, 1990, designate one or more instruments which are consistent with the specification made under subparagraph (A) and which a State may specify under subsection (e)(5)(A) for use by nursing facilities in complying with the requirements of subsection (b)(3)(A)(iii).
(7) List of items and services furnished in skilled nursing facilities not chargeable to the personal funds of a resident.—
(A) Regulations required.—Pursuant to the requirement of section 21(b) of the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977[66], the Secretary shall issue regulations, on or before the first day of the seventh month to begin after the date of enactment of this section[67], that define those costs which may be charged to the personal funds of residents in skilled nursing facilities who are individuals receiving benefits under this part and those costs which are to be included in the reasonable cost (or other payment amount) under this title for extended care services.
(B) Rule if failure to publish regulations.—If the Secretary does not issue the regulations under subparagraph (A) on or before the date required in such subparagraph, in the case of a resident of a skilled nursing facility who is eligible to receive benefits under this part, the costs which may not be charged to the personal funds of such resident (and for which payment is considered to be made under this title) shall include, at a minimum, the costs for routine personal hygiene items and services furnished by the facility.
(8) Special focus facility program.—
(A) In general.—The Secretary shall conduct a special focus facility program for enforcement of requirements for skilled nursing facilities that the Secretary has identified as having substantially failed to meet applicable requirement of this Act.
(B) Periodic surveys.—Under such program the Secretary shall conduct surveys of each facility in the program not less than once every 6 months.
(g) Survey and Certification Process.—
(1) State and federal responsibility.—
(A) In general.—Pursuant to an agreement under section 1864, each State shall be responsible for certifying, in accordance with surveys conducted under paragraph (2), the compliance of skilled nursing facilities (other than facilities of the State) with the requirements of subsections (b), (c), and (d). The Secretary shall be responsible for certifying, in accordance with surveys conducted under paragraph (2), the compliance of State skilled nursing facilities with the requirements of such subsections.
(B) Educational program.—Each State shall conduct periodic educational programs for the staff and residents (and their representatives) of skilled nursing facilities in order to present current regulations, procedures, and policies under this section.
(C) Investigation of allegations of resident neglect and abuse and misappropriation of resident property.—The State shall provide, through the agency responsible for surveys and certification of nursing facilities under this subsection, for a process for the receipt and timely review and investigation of allegations of neglect and abuse and misappropriation of resident property by a nurse aide of a resident in a nursing facility or by another individual used by the facility in providing services to such a resident. The State shall, after providing the individual involved with a written notice of the allegations (including a statement of the availability of a hearing for the individual to rebut the allegations) and the opportunity for a hearing on the record, make a written finding as to the accuracy of the allegations. If the State finds that a nurse aide has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the nurse aide and the registry of such finding. If the State finds that any other individual used by the facility has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the appropriate licensure authority. A State shall not make a finding that an individual has neglected a resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual.
(D) Removal of name from nurse aide registry.—
(i) In general.—In the case of a finding of neglect under subparagraph (C), the State shall establish a procedure to permit a nurse aide to petition the State to have his or her name removed from the registry upon a determination by the State that—
(I) the employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect; and
(II) the neglect involved in the original finding was a singular occurrence.
(ii) Timing of determination.—In no case shall a determination on a petition submitted under clause (i) be made prior to the expiration of the 1–year period beginning on the date on which the name of the petitioner was added to the registry under subparagraph (C).
(E) Construction.—The failure of the Secretary to issue regulations to carry out this subsection shall not relieve a State of its responsibility under this subsection.
(2) Surveys.—
(A) Standard survey.—
(i) In general.—Each skilled nursing facility shall be subject to a standard survey, to be conducted without any prior notice to the facility. Any individual who notifies (or causes to be notified) a skilled nursing facility of the time or date on which such a survey is scheduled to be conducted is subject to a civil money penalty of not to exceed $2,000. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). The Secretary shall review each State's procedures for the scheduling and conduct of standard surveys to assure that the State has taken all reasonable steps to avoid giving notice of such a survey through the scheduling procedures and the conduct of the surveys themselves.
(ii) Contents.—Each standard survey shall include, for a case-mix stratified sample of residents—
(I) a survey of the quality of care furnished, as measured by indicators of medical, nursing, and rehabilitative care, dietary and nutrition services, activities and social participation, and sanitation, infection control, and the physical environment,
(II) written plans of care provided under subsection (b)(2) and an audit of the residents' assessments under subsection (b)(3) to determine the accuracy of such assessments and the adequacy of such plans of care, and
(III) a review of compliance with residents' rights under subsection (c).
(iii) Frequency.—
(I) In general.—Each skilled nursing facility shall be subject to a standard survey not later than 15 months after the date of the previous standard survey conducted under this subparagraph. The Statewide average interval between standard surveys of skilled nursing facilities under this subsection shall not exceed 12 months.
(II) Special surveys.—If not otherwise conducted under subclause (I), a standard survey (or an abbreviated standard survey) may be conducted within 2 months of any change of ownership, administration, management of a skilled nursing facility, or the director of nursing in order to determine whether the change has resulted in any decline in the quality of care furnished in the facility.
(B) Extended surveys.—
(i) In general.—Each skilled nursing facility which is found, under a standard survey, to have provided substandard quality of care shall be subject to an extended survey. Any other facility may, at the Secretary's or State's discretion, be subject to such an extended survey (or a partial extended survey).
(ii) Timing.—The extended survey shall be conducted immediately after the standard survey (or, if not practicable, not later than 2 weeks after the date of completion of the standard survey).
(iii) Contents.—In such an extended survey, the survey team shall review and identify the policies and procedures which produced such substandard quality of care and shall determine whether the facility has complied with all the requirements described in subsections (b), (c), and (d). Such review shall include an expansion of the size of the sample of residents' assessments reviewed and a review of the staffing, of in-service training, and, if appropriate, of contracts with consultants.
(iv) Construction.—Nothing in this paragraph shall be construed as requiring an extended or partial extended survey as a prerequisite to imposing a sanction against a facility under subsection (h) on the basis of findings in a standard survey.
(C) Survey protocol.—Standard and extended surveys shall be conducted—
(i) based upon a protocol which the Secretary has developed, tested, and validated by not later than January 1, 1990, and
(ii) by individuals, of a survey team, who meet such minimum qualifications as the Secretary establishes by not later than such date.
The failure of the Secretary to develop, test, or validate such protocols or to establish such minimum qualifications shall not relieve any State of its responsibility (or the Secretary of the Secretary's responsibility) to conduct surveys under this subsection.
(D) Consistency of surveys.—Each State and the Secretary shall implement programs to measure and reduce inconsistency in the application of survey results among surveyors.
(E) Survey teams.—
(i) In general.—Surveys under this subsection shall be conducted by a multidisciplinary team of professionals (including a registered professional nurse).
(ii) Prohibition of conflicts of interest.—A State may not use as a member of a survey team under this subsection an individual who is serving (or has served within the previous 2 years) as a member of the staff of, or as a consultant to, the facility surveyed respecting compliance with the requirements of subsections (b), (c), and (d), or who has a personal or familial financial interest in the facility being surveyed.
(iii) Training.—The Secretary shall provide for the comprehensive training of State and Federal surveyors in the conduct of standard and extended surveys under this subsection, including the auditing of resident assessments and plans of care. No individual shall serve as a member of a survey team unless the individual has successfully completed a training and testing program in survey and certification techniques that has been approved by the Secretary.
(3) Validation surveys.—
(A) In general.—The Secretary shall conduct onsite surveys of a representative sample of skilled nursing facilities in each State, within 2 months of the date of surveys conducted under paragraph (2) by the State, in a sufficient number to allow inferences about the adequacies of each State's surveys conducted under paragraph (2). In conducting such surveys, the Secretary shall use the same survey protocols as the State is required to use under paragraph (2). If the State has determined that an individual skilled nursing facility meets the requirements of subsections (b), (c), and (d), but the Secretary determines that the facility does not meet such requirements, the Secretary's determination as to the facility's noncompliance with such requirements is binding and supersedes that of the State survey.
(B) Scope.—With respect to each State, the Secretary shall conduct surveys under subparagraph (A) each year with respect to at least 5 percent of the number of skilled nursing facilities surveyed by the State in the year, but in no case less than 5 skilled nursing facilities in the State.
(C) Remedies for substandard performance.—If the Secretary finds, on the basis of such surveys, that a State has failed to perform surveys as required under paragraph (2) or that a State's survey and certification performance otherwise is not adequate, the Secretary shall provide for an appropriate remedy, which may include the training of survey teams in the State.
(D) Special surveys of compliance.—Where the Secretary has reason to question the compliance of a skilled nursing facility with any of the requirements of subsections (b), (c), and (d), the Secretary may conduct a survey of the facility and, on the basis of that survey, make independent and binding determinations concerning the extent to which the skilled nursing facility meets such requirements.
(4) Investigation of complaints and monitoring compliance.—Each State shall maintain procedures and adequate staff to—
(A) investigate complaints of violations of requirements by skilled nursing facilities, and
(B) monitor, on-site, on a regular, as needed basis, a skilled nursing facility's compliance with the requirements of subsections (b), (c), and (d), if—
(i) the facility has been found not to be in compliance with such requirements and is in the process of correcting deficiencies to achieve such compliance;
(ii) the facility was previously found not to be in compliance with such requirements, has corrected deficiencies to achieve such compliance, and verification of continued compliance is indicated; or
(iii) the State has reason to question the compliance of the facility with such requirements.
A State may maintain and utilize a specialized team (including an attorney, an auditor, and appropriate health care professionals) for the purpose of identifying, surveying, gathering and preserving evidence, and carrying out appropriate enforcement actions against substandard skilled nursing facilities.
(5) Disclosure of results of inspections and activities.—
(A) Public information.—Each State, and the Secretary, shall make available to the public—
(i) information respecting all surveys and certifications made respecting skilled nursing facilities, including statements of deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans of correction,
(ii) copies of cost reports of such facilities filed under this title or title XIX,
(iii) copies of statements of ownership under section 1124, and
(iv) information disclosed under section 1126.
(B) Notice to ombudsman.—Each State shall notify the State long-term care ombudsman (established under title III or VII of the Older Americans Act of 1965[68] in accordance with section 712 of the Act) of the State's findings of noncompliance with any of the requirements of subsections (b), (c), and (d), or of any adverse action taken against a skilled nursing facility under paragraph (1), (2), or (4) of subsection (h), with respect to a skilled nursing facility in the State.
(C) Notice to physicians and skilled nursing facility administrator licensing board.—If a State finds that a skilled nursing facility has provided substandard quality of care, the State shall notify—
(i) the attending physician of each resident with respect to which such finding is made, and
(ii) the State board responsible for the licensing of the skilled nursing facility administrator at the facility.
(D) Access to fraud control units.—Each State shall provide its State medicaid fraud and abuse control unit (established under section 1903(q)) with access to all information of the State agency responsible for surveys and certifications under this subsection.
(E) Submission of survey and certification information to the secretary.—In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification made respecting a nursing facility (including any enforcement actions taken by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable but not less frequently than quarterly.
(h) Enforcement Process.—
(1) In general.—If a State finds, on the basis of a standard, extended, or partial extended survey under subsection (g)(2) or otherwise, that a skilled nursing facility no longer meets a requirement of subsection (b), (c), or (d), and further finds that the facility's deficiencies—
(A) immediately jeopardize the health or safety of its residents, the State shall recommend to the Secretary that the Secretary take such action as described in paragraph (2)(A)(i); or
(B) do not immediately jeopardize the health or safety of its residents, the State may recommend to the Secretary that the Secretary take such action as described in paragraph (2)(A)(ii).
If a State finds that a skilled nursing facility meets the requirements of subsections (b), (c), and (d), but, as of a previous period, did not meet such requirements, the State may recommend a civil money penalty under paragraph (2)(B)(ii) for the days in which it finds that the facility was not in compliance with such requirements.
(2) Secretarial authority.—
(A) In general.—With respect to any skilled nursing facility in a State, if the Secretary finds, or pursuant to a recommendation of the State under paragraph (1) finds, that a skilled nursing facility no longer meets a requirement of subsection (b), (c), (d), or (e), and further finds that the facility's deficiencies—
(i) immediately jeopardize the health or safety of its residents, the Secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy specified in subparagraph (B)(iii), or terminate the facility's participation under this title and may provide, in addition, for one or more of the other remedies described in subparagraph (B); or
(ii) do not immediately jeopardize the health or safety of its residents, the Secretary may impose any of the remedies described in subparagraph (B).
Nothing in this subparagraph shall be construed as restricting the remedies available to the Secretary to remedy a skilled nursing facility's deficiencies. If the Secretary finds, or pursuant to the recommendation of the State under paragraph (1) finds, that a skilled nursing facility meets such requirements but, as of a previous period, did not meet such requirements, the Secretary may provide for a civil money penalty under subparagraph (B)(ii) for the days on which he finds that the facility was not in compliance with such requirements.
(B) Specified remedies.—The Secretary may take the following actions with respect to a finding that a facility has not met an applicable requirement:
(i) Denial of payment.—The Secretary may deny any further payments under this title with respect to all individuals entitled to benefits under this title in the facility or with respect to such individuals admitted to the facility after the effective date of the finding.
(ii) Authority with respect to civil money penalties.—
(I) In general.—Subject to subclause (II), the Secretary may impose a civil money penalty in an amount not to exceed $10,000 for each day of noncompliance. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
(II) Reduction of civil money penalties in certain circumstances.—Subject to subclause (III), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
(III) Prohibitions on reduction for certain deficiencies.—
(aa) Repeat deficiencies.—The Secretary may not reduce the amount of a penalty under subclause (II) if the Secretary had reduced a penalty imposed on the facility in the preceding year under such subclause with respect to a repeat deficiency.
(bb) Certain other deficiencies.—The Secretary may not reduce the amount of a penalty under subclause (II) if the penalty is imposed on the facility for a deficiency that is found to result in a pattern of harm or widespread harm, immediately jeopardizes the health or safety of a resident or residents of the facility, or results in the death of a resident of the facility.
(IV) Collection of civil money penalties.—In the case of a civil money penalty imposed under this clause, the Secretary shall issue regulations that—
(aa) subject to item (cc), not later than 30 days after the imposition of the penalty, provide for the facility to have the opportunity to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty;
(bb) in the case where the penalty is imposed for each day of noncompliance, provide that a penalty may not be imposed for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
(cc) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary on the earlier of the date on which the informal dispute resolution process under item (aa) is completed or the date that is 90 days after the date of the imposition of the penalty;
(dd) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
(ee) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
(ff) in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and
(iii) Appointment of temporary management.—In consultation with the State, the Secretary may appoint temporary management to oversee the operation of the facility and to assure the health and safety of the facility's residents, where there is a need for temporary management while—
(I) there is an orderly closure of the facility, or
(II) improvements are made in order to bring the facility into compliance with all the requirements of subsections (b), (c), and (d).
The temporary management under this clause shall not be terminated under subclause (II) until the Secretary has determined that the facility has the management capability to ensure continued compliance with all the requirements of subsections (b), (c), and (d).
The Secretary shall specify criteria, as to when and how each of such remedies is to be applied, the amounts of any fines, and the severity of each of these remedies, to be used in the imposition of such remedies. Such criteria shall be designed so as to minimize the time between the identification of violations and final imposition of the remedies and shall provide for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies. In addition, the Secretary may provide for other specified remedies, such as directed plans of correction.
(C) Continuation of payments pending remediation.—The Secretary may continue payments, over a period of not longer than 6 months after the effective date of the findings, under this title with respect to a skilled nursing facility not in compliance with a requirement of subsection (b), (c), or (d), if—
(i) the State survey agency finds that it is more appropriate to take alternative action to assure compliance of the facility with the requirements than to terminate the certification of the facility,
(ii) the State has submitted a plan and timetable for corrective action to the Secretary for approval and the Secretary approves the plan of corrective action, and
(iii) the facility agrees to repay to the Federal Government payments received under this subparagraph if the corrective action is not taken in accordance with the approved plan and timetable.
The Secretary shall establish guidelines for approval of corrective actions requested by States under this subparagraph.
(D) Assuring prompt compliance.—If a skilled nursing facility has not complied with any of the requirements of subsections (b), (c), and (d), within 3 months after the date the facility is found to be out of compliance with such requirements, the Secretary shall impose the remedy described in subparagraph (B)(i) for all individuals who are admitted to the facility after such date.
(E) Repeated noncompliance.—In the case of a skilled nursing facility which, on 3 consecutive standard surveys conducted under subsection (g)(2), has been found to have provided substandard quality of care, the Secretary shall (regardless of what other remedies are provided)—
(i) impose the remedy described in subparagraph (B)(i), and
(ii) monitor the facility under subsection (g)(4)(B),
until the facility has demonstrated, to the satisfaction of the Secretary, that it is in compliance with the requirements of subsections (b), (c), and (d), and that it will remain in compliance with such requirements.
(3) Effective period of denial of payment.—A finding to deny payment under this subsection shall terminate when the Secretary finds that the facility is in substantial compliance with all the requirements of subsections (b), (c), and (d).
(4) Immediate termination of participation for facility where secretary finds noncompliance and immediate jeopardy.—If the Secretary finds that a skilled nursing facility has not met a requirement of subsection (b), (c), or (d), and finds that the failure immediately jeopardizes the health or safety of its residents, the Secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy specified in paragraph (2)(B)(iii), or the Secretary, subject to section 1128I(h) shall terminate the facility's participation under this title. If the facility's participation under this title is terminated, the State shall provide for the safe and orderly transfer of the residents eligible under this title consistent with the requirements of subsection (c)(2) and section 1128I(h).
(5) Construction.—The remedies provided under this subsection are in addition to those otherwise available under State or Federal law and shall not be construed as limiting such other remedies, including any remedy available to an individual at common law. The remedies described in clauses (i), (ii)((IV), and (iii) of paragraph (2)(B) may be imposed during the pendency of any hearing.
(6) Sharing of information.—Notwithstanding any other provision of law, all information concerning skilled nursing facilities required by this section to be filed with the Secretary or a State agency shall be made available by such facilities to Federal or State employees for purposes consistent with the effective administration of programs established under this title and title XIX, including investigations by State medicaid fraud control units.
(i) Nursing Home Compare Website.—
(1) Inclusion of additional information.—
(A) In general.—The Secretary shall ensure that the Department of Health and Human Services includes, as part of the information provided for comparison of nursing homes on the official Internet website of the Federal Government for Medicare beneficiaries (commonly referred to as the "Nursing Home Compare" Medicare website) (or a successor website), the following information in a manner that is prominent, updated on a timely basis, easily accessible, readily understandable to consumers of long-term care services, and searchable:
(i) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under section 1128I(g), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilities. Such format shall include—
(I) concise explanations of how to interpret the data (such as a plain English explanation of data reflecting "nursing home staff hours per resident day");
(II) differences in types of staff (such as training associated with different categories of staff);
(III) the relationship between nurse staffing levels and quality of care; and
(IV) an explanation that appropriate staffing levels vary based on patient case mix.
(ii) Links to State Internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and the facility plan of correction or other response to such report. Any such links shall be posted on a timely basis.
(iii) The standardized complaint form developed under section 1128I(f), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.
(iv) Summary information on the number, type, severity, and outcome of substantiated complaints.
(v) The number of adjudicated instances of criminal violations by a facility or the employees of a facility—
(I) that were committed inside the facility;
(II) with respect to such instances of violations or crimes committed inside of the facility that were the violations or crimes of abuse, neglect, and exploitation, criminal sexual abuse, or other violations or crimes that resulted in serious bodily injury; and
(III) the number of civil monetary penalties levied against the facility, employees, contractors, and other agents.
(B) Deadline for provision of information.—
(i) In general.—Except as provided in clause (ii), the Secretary shall ensure that the information described in subparagraph (A) is included on such website (or a successor website) not later than 1 year after the date of the enactment of this subsection.
(ii) Exception.—The Secretary shall ensure that the information described in subparagraph (A)(i) is included on such website (or a successor website) not later than the date on which the requirements under section 1128I(g) are implemented.
(2) Review and modification of website.—
(A) In general.—The Secretary shall establish a process—
(i) to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
(ii) not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
(B) Consultation.—In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
(i) State long-term care ombudsman programs;
(ii) consumer advocacy groups;
(iii) provider stakeholder groups; and
(iv) any other representatives of programs or groups the Secretary determines appropriate.
(3) Funding. — The Secretary shall transfer to the Centers for Medicare & Medicaid Services Program Management Account, from the Federal Hospital Insurance Trust Fund under section 1817 a one-time allocation of $11,000,000. The amount shall be available on the date of the enactment of this paragraph. Such sums shall remain available until expended. Such sums shall be used to implement section 1128I(g).
(j) Construction.—Where requirements or obligations under this section are identical to those provided under section 1919 of this Act, the fulfillment of those requirements or obligations under section 1919 shall be considered to be the fulfillment of the corresponding requirements or obligations under this section.
[58] See Vol. II, P.L. 100-203, §4205, with respect to the annual report to Congress.
See Vol. II, P.L. 108-173, §107(b), with respect to a review and report on current standards of practice for pharmacy services provided to patients in nursing facilities.
See Vol. II, P.L. 111-148, §6103(e), with respect to the development of consumer rights information page on nursing home compare website.
See Vol. II, P.L. 111-148, §6112, with respect to a national independent monitor demonstration project.
See Vol. II, P.L. 111-148, §6114, with respect to national demonstration projects on culture change and use of information technology in nursing homes.
[59] See Vol. II, P.L. 101-508, §4008(h)(2)(O), with respect to maintaining regulatory standards for certain services.
[60] See Vol. II, P.L. 89-73.
[61] See Vol. II, P.L. 89-73.
[62] P.L. 111-148, §6101(c)(1)(A), strikes out subparagraph (B) and redesignates the former subparagraph (C) as (B), effective on the date on which the Secretary makes the information described in subsection (b) available to the public. See Vol. II, P.L. 111-148, §6101(b), with respect to the public availability of information — not later than the date that is 1 year after the date on which the final regulations promulgated under section 1124(c)(3)(A) — as added by P.L. 111-148, §6101(a). The Secretary shall promulgate such regulations not later than March 23, 2012. On the date the Secretary makes the information available to the public, the subparagraph (B) will read as the current subparagraph (C):
Nursing facility administrator.—
The administrator of a nursing facility must meet standards established by the Secretary under subsection (f)(4).
[63] See Vol. II, P.L. 111-148, §6103(d), with respect to guidance to States on Form 2567 State Inspection Reports and Compliant Investigation Reports.
[64] As in original. Closing parenthesis missing.
[65] December 22, 1987 [P.L. 100-203; 101 Stat. 1330–160].
[66] See Vol. II, P.L. 95-142.
[67] December 22, 1987 [P.L. 100-203; 101 Stat. 1330–160].
[68] See Vol. II, P.L. 89-73.


text:
India is expanding a covert uranium enrichment plant that could potentially support the development of thermonuclear weapons, a defence research group said on Friday, raising the stakes in an arms race with China and Pakistan.
The revelation highlights a lack of nuclear safeguards on India under new Prime Minister Narendra Modi, while sanctions-bound Iran faces minute scrutiny in talks with world powers over its own nuclear programme.
New units at the Indian Rare Metals Plant would increase India's ability to produce weapons-grade uranium to twice the amount needed for its planned nuclear-powered submarine fleet, IHS Jane's said.
The facility, located near Mysore in southern India, could be operational by mid-2015, the research group said, basing its findings on analysis of satellite imagery and public statements by Indian officials.
"Taking into account all the enriched uranium likely to be needed by the Indian nuclear submarine fleet, there is likely to be a significant excess," Matthew Clements, editor of IHS Jane's Intelligence Review said.
"One potential use of this would be for the development of thermonuclear weapons." No comment was available from the Indian government press office or the foreign ministry.
Unlike Iran, India is not a signatory to the nuclear Non-Proliferation Treaty. New Delhi tested its first nuclear weapon in 1974, provoking international sanctions that barred it from importing nuclear technology and materials.
It conducted tests again in 1998 that drew a quick response from Pakistan, triggering an arms race between the neighbours, who have fought three wars since independence in 1947.
A civil nuclear cooperation deal with the United States, sealed in 2008, gave India access to know-how and fuel in return for a pledge – so far unfulfilled – to bring in U.S. firms to expand India's nuclear power generation capacity.
The pact exempts military facilities and stockpiles of nuclear fuel from scrutiny by the International Atomic Energy Agency, a United Nations watchdog. The Mysore plant is not subject to IAEA safeguards.
The exemption, granted by the administration of President George W. Bush, faced opposition from China and Pakistan, India's regional rivals, and European nations who said it would undermine efforts to control the spread of nuclear weapons.
Satellite view
Based on its analysis of commercial satellite images, IHS Jane's has identified what appears to be a new uranium hexafluoride plant that would increase the uranium enrichment capacity of the Mysore facility.
The plant would be able to produce a surplus of around 160 kilos a year of uranium enriched to 90 percent purity, IHS Jane's reckons. That is roughly double the needs of the nuclear submarine fleet India is developing to supplement its land-based missile arsenal – and enough to make five atomic bombs.
By blending the uranium with its existing stock of plutonium, India could develop thermonuclear weapons that have a complex detonation process and have a bigger impact than simpler weapons.
"We aren't suggesting that this action alone will create an immediate standoff, but it's going to create a further level of complexity in an already difficult situation," said Clements, referring to the regional security implications.
The IHS findings have been corroborated by other analysts, with the Stockholm International Peace Research Institute (SIPRI) writing this week that the Mysore facility could signify India's intent to move towards thermonuclear weapons.
India is estimated by SIPRI to hold 90 to 110 nuclear weapons in its arsenal.
The IHS assessment revealed incremental progress at Mysore since the Washington-based Institute for Science and International Security (ISIS), in a report last December, identified the construction of a new gas centrifuge plant.
India's new Arihant class of submarine is assessed to have an 80-megawatt onboard reactor that contains around 65kg of uranium. One submarine is operational, a second is being built and a third is planned, according to ISIS.
No first use
Modi, leader of the nationalist Bharatiya Janata Party, has sought to assert New Delhi's regional leadership in his first weeks in office while seeking to engage with major powers such as the United States and China.
But, although he invited Pakistan's prime minister to his inauguration, Modi has made clear that any rapprochement would require a halt to occasional military clashes on the de facto frontier of the disputed Himalayan region of Kashmir.
Before Modi's landslide general election victory last month, sources close to his party had suggested India might abandon its 'no first use' nuclear doctrine, which committed it to refrain from any pre-emptive strike.
Modi later denied any planned shift and vowed to uphold 'no first use', a signature policy of India's last BJP prime minister, Atal Bihari Vajpayee, who ordered the 1998 nuclear tests.


text:
Comprised of a diverse set of student-centered departments and programs, the Division of Student Affairs fosters student learning and development within our vibrant residential community – where self-governance and personal responsibility are hallmarks. The programs, services, and resources provided by dedicated and caring student affairs educators are designed for your success. We encourage you to get involved, seek assistance and support, develop respectful and meaningful relationships, maintain personal wellness, learn about and appreciate difference, and help keep our community safe.
Student Affairs
Department Information
Phone(641) 269-3700
Fax(641) 269-3710
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text:
Recently my good friend Isabelle Rapin brought to my attention an article published in the Journal of Autism and Developmental Disorders. The article was conducted by Dr. Rubin Jure from Cordoba, Argentina and was entitled, "Autism Spectrum Disorders (ASD) in Blind Children: Very High Prevalence, Potentially Better Outlook". Dr. Jure has no formal academic affiliations and undertook this project based on personal observations in children that he had seen in his solo practice of Child Neurology. Dr. Jure conceived the study and conducted the same on his own and only after its completion decided to consult with Dr. Rapin.
The study was based on an unselected sample of 38 children at a school for the blind. Half of the children (n=19) had an autism spectrum diagnosis (ASD). The high prevalence of ASD in the blind is well known in the literature and may account, to a certain degree, as to why a significant percentage of individuals with congenital rubella manifest an autism phenotype.
The results of series detailing a correlation between ASD and blindness suggest that autistic phenotype is not dependent on the cause of the blindness but to the fact that the latter is complete and congenital in origin. What appears startling is that many of the blind children who exhibit ASD: 1) do not exhibit a gender bias, and 2) may lose their diagnosis with time. In a series by Hobson and Lee (2010) 8 of 9 blind children lost their ASD diagnosis when re-evaluated as adolescents. Dr. Jure's review of 12 published studies totaling 859 early blinded children indicates the staggering prevalence of 48%. ASD as a comorbidity is peculiar to this sensory abnormality and not, for example, to deafness.
The authors of the article discuss some of the reasons why this high correlation has not received more attention in medical literature:
1) Childhood blindness is the least prevalent (0.33%) of all developmental disabilities. Furthermore, only ophthalmologists and specialized clinicians are able to take care of these children.
2) Attending clinicians feel compelled to identify the major incapacitating symptom. Autism in this regard takes a back seat to blindness.
3) There is an unawareness that the correlation exists primarily for congenital total lack of vision beyond light perception and not the etiology of the blindness. Some series of blind individuals may not comply with these observations and their heterogeneous population may not yield the indicated high prevalence rates.
4) Physicians may be reluctant to discuss a second disabling diagnosis with parents of a blind child. They may think it might inflict more pain and suffering on the parents.
The blueprint of connectivity of the brain of a blind individual is different from that of a typically developing child. It is posited that the plasticity ingrained in further rewiring the brain of a blind individual may confer some type of advantage that improves the outlook of autism, some children thus losing their diagnosis during adolescence.
In their conclusions the authors state:
"The time has come for professionals to be aware of congenital blindness (CB) universal consequences for brain structure and function, enabling them to help parents understand the unique and profound brain and experiential consequences of congenital lack of vision. They also need to explain to parents of all children affected by an ASD that it is not a "disease" but defines a particular group of behavioral symptoms of variable severity with differing pathophysiologies depending on its cause. They need to emphasize that ASD in congenital blindness has special characteristics and that all else being equal, the outlook for abatement of autistic symptoms may be somewhat better, long term, in some CB children than sighted children. Pediatricians and other professionals, cognizant of the high risk of ASD in CB, must be on the lookout and make sure blind babies and children's development is followed closely and that they are provided with optimal social and intellectual nurturing from birth to prevent or remediate them if there are premonitory or overt ASD symptoms. For researchers CB/ASD provides unique investigative opportunities and ideas for research models, some of which may spill over into better understanding and management of all children with ASD."
A Spanish version translated from the English version by Alexia Rattazzi MD can be obtained from email@example.com
Hobson RP, Lee A. Reversible autism among congenitally blind children? A controlled follow-up study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51(11):1235-1241, 2010.
Jure R, Pogonza R, Rapin I. Autism Spectrum Disorders (ASD) in Blind Children: very High Prevalence, Potnetially Better Outlook, JADD 46:749-759, 2016.