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Rh to residents’ rights,” the Act requires recipients to “protect and promote the rights of each resident,” including “[t]he right to choose a personal attending physician” and make informed medical decisions; “[t]he right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any [medically unnecessary] physical or chemical restraints”; and “[t]he right[s] to privacy” and “confidentiality.” 42 U. S. C. §§§ [sic]1396r(c)(1)(A)(i)–(iv). The Act further provides that funding recipients “must permit each resident to remain in the facility and must not transfer or discharge the resident” without cause. §1396r(c)(2)(A). Recipients must also adopt procedures for residents to assert these “rights” and to otherwise “voice grievances with respect to [their] treatment or care.” §1396r(c)(1)(A)(vi).

The Act also imposes many requirements directly and uniquely upon participating States, including in a subsection entitled “State requirements relating to nursing facility requirements.” §1396r(e). For instance, States must establish procedures for residents to challenge transfer and discharge decisions and an appeals process for other determinations. §§§ [sic]1396r(e)(3) and (e)(7)(F). States are also required to certify non-state-run facilities’ compliance with the Act’s provisions by conducting annual surveys using protocols developed by the Secretary of Health and Human Services. §1396r(g)(2)(A). If a State finds that a facility is not providing adequate care, it must conduct an extended survey. §1396r(g)(2)(B). The Act also requires States to investigate resident complaints and perform onsite monitoring at previously noncompliant or potentially noncompliant facilities. §1396r(g)(4)(B). And, if it finds a violation that “jeopardize[s] the health or safety of [a facility’s] residents, the State shall take immediate action to remove the jeopardy and correct the deficiencies.” §1396r(h)(1)(A).