³California's "Little Hoover Commission" is a state oversight agency credited with issuing reports, such as a 1983 study of skilled nursing facilities (California 1983) that led to state reforms, including the creation of a system of citations and fines that put teeth in the regulatory system. New York's Moreland Act Commission was created partly in response to scandals in facilities owned by Bernard Bergman and to concerns that the abysmal care and regulatory failures found in Bergman's facilities were widespread. The series of reports issued by the Moreland Act Commission (New York 1975, 1976) led to some reforms in New York. Similarly, the Ohio legislature's Nursing Home Commission (Ohio 1978) found and documented significant and widespread quality problems and followed with a blueprint for needed policy changes (Ohio 1979), a residents' bill of rights, and two omnibus reform bills. The bill of rights and one reimbursement reform bill were enacted before the two-year commission expired, but the other omnibus quality improvement reform bill, which came to be known as "little OBRA," was not enacted until 11 years later, following the passage of OBRA '87 at the national level.[Return to Text]