Arbitration agreements in medical and nursing home care

An arbitration agreement is a document in which you agree that a dispute will be decided by an arbitrator instead of a judge or jury. A “pre-dispute” agreement is signed before any problem has happened, sometimes as part of new-patient or admission paperwork, and it can cover later claims about the care you receive. Federal rules limit how nursing homes may use these agreements, and states have their own rules for medical care.

We don’t tell anyone whether to sign. This guide explains what these agreements are and what the rules say, so you can read the document, ask questions, and talk with an attorney licensed in your state before signing if you’re unsure. We are not attorneys, and we never evaluate anyone’s situation.

What a pre-dispute arbitration agreement is

In arbitration, a private arbitrator or panel hears the dispute and makes a decision, instead of a court. When the agreement is “binding,” the parties agree to follow that decision.

There are two basic kinds:

• Pre-dispute agreements are signed before anything has gone wrong. They say that if a dispute arises later, it will go to arbitration.
• Post-dispute agreements are made after a dispute already exists, when both sides choose arbitration for that dispute.

An arbitration clause may be a separate form, or it may be one section inside a longer agreement, so it helps to read the whole document, not just its title. California’s statute, discussed below, shows what one type of medical arbitration clause looks like when state law dictates its wording.

The Federal Arbitration Act in plain terms

The Federal Arbitration Act says that a written provision in “a contract evidencing a transaction involving commerce” to settle future disputes by arbitration “shall be valid, irrevocable, and enforceable, save upon such grounds as exist at law or in equity for the revocation of any contract or as otherwise provided in chapter 4” (9 U.S.C. § 2).

In plain terms, federal law generally treats a written arbitration agreement covered by the Act like other contracts: it can be enforced, and it can be challenged on the same grounds that could undo any contract. Whether a particular agreement is covered, and whether any defense applies, are legal questions for an attorney and, if it comes to that, a court.

The “chapter 4” exception was added in 2022. It lets a person alleging sexual assault or sexual harassment choose not to be bound by a pre-dispute arbitration agreement for a case relating to that conduct, and it applies to disputes or claims that arise or accrue on or after March 3, 2022 (9 U.S.C. § 402).

The federal rule for nursing homes

Nursing homes that take part in Medicare or Medicaid must follow a specific federal rule if they ask a resident or the resident’s representative to sign a binding arbitration agreement. Under 42 C.F.R. § 483.70(m):

• It can’t be a condition of admission or care. The facility “must not require” anyone to sign as a condition of admission or to continue to receive care, and must explicitly tell the resident or representative of the right not to sign. The agreement itself must say so too (§ 483.70(m)(1), (4)).
• It must be explained. The agreement must be explained in a form, manner and language the resident and representative understand, and they must acknowledge that they understand it (§ 483.70(m)(2)(i)–(ii)).
• A neutral arbitrator and a convenient venue. The agreement must provide for a neutral arbitrator agreed on by both parties and a venue convenient to both (§ 483.70(m)(2)(iii)–(iv)).
• A 30-day right to rescind. The agreement must explicitly give the resident or representative the right to rescind it “within 30 calendar days of signing it” (§ 483.70(m)(3)).
• No gag on reporting. The agreement may not contain language that prohibits or discourages anyone from communicating with federal, state or local officials, including surveyors and the State Long-Term Care Ombudsman (§ 483.70(m)(5)).
• Records kept. When a dispute is resolved through arbitration, the facility must keep the signed agreement and the arbitrator’s final decision for 5 years and make them available to CMS on request (§ 483.70(m)(6)).

Separately, a nursing home may not prohibit or discourage a resident from communicating with officials about any matter, “whether or not subject to arbitration” (42 C.F.R. § 483.10(k)). When CMS adopted the 30-day rescission right, it explained that the window “allows the resident to seek legal advice, if he or she chooses to do so” (84 FR 34718).

These federal requirements apply to nursing homes certified for Medicare or Medicaid. They don’t govern arbitration agreements at a doctor’s office or other settings, where state law and the Federal Arbitration Act are the main rules.

State examples: California and Florida

States handle medical arbitration differently. Two examples show how different the approaches can be.

California: required wording and a 30-day window

In California, any contract for medical services that includes arbitration of professional negligence claims must put that provision as the first article of the contract, in wording set by statute. That wording says both parties are “giving up their constitutional right to have any such dispute decided in a court of law before a jury.” A notice in at least 10-point bold red type must appear immediately before the signature line. The contract can be rescinded by written notice within 30 days of signature (Cal. Code Civ. Proc. § 1295).

Florida: voluntary arbitration after a claim is made

Florida’s statute on “voluntary binding arbitration of medical negligence claims” works differently: it isn’t a pre-dispute agreement signed at a first visit. After the presuit investigation required before a medical negligence lawsuit, either side may ask to have damages decided by an arbitration panel, and the other side may accept within set time limits. Acceptance is “a binding commitment to comply with the decision of the arbitration panel” (Fla. Stat. § 766.207(2)–(3)).

The panel has three arbitrators: one chosen by the claimant, one by the defendant, and an administrative law judge who serves as chief arbitrator. Arbitration under this section “shall preclude recourse to any other remedy by the claimant against any participating defendant,” and the statute sets limits on the damages that can be awarded (§ 766.207(4), (7)). The presuit steps themselves are described in Fla. Stat. § 766.106.

Other states have their own rules. An attorney licensed in your state can explain which rules apply to a particular agreement.

If you’re asked to sign one

We don’t recommend signing or not signing. These are neutral steps that can help you understand what you’re being asked to agree to:

1. Read the whole document. Look for words like “arbitration,” “binding,” “waive” and “jury.”
2. Ask whether it’s required. For a Medicare- or Medicaid-certified nursing home, federal rules say it can’t be a condition of admission or continued care. At other providers, ask directly.
3. Ask about cancelling. Is there a right to rescind? How many days, and how must notice be given?
4. Ask what it covers. Which kinds of disputes, which providers, and who is bound by it.
5. Ask how the arbitrator is chosen and where arbitration would happen.
6. Ask for time and a copy. Keep a copy of anything you sign, with the date.
7. Talk with an attorney licensed in your state before signing if you’re unsure what it means for you.

If you’re signing for someone else, such as a parent entering a nursing home, the same questions apply. It’s also worth asking who is bound when a representative signs; an attorney licensed in your state can answer that.

If you already signed one

• Check the rescission window. For certified nursing homes, federal rules require a 30-day right to rescind. In California, the medical services statute allows rescission by written notice within 30 days of signature. Other agreements may have different terms, or none.
• Find your copy. If you don’t have one, ask the provider for a copy of what you signed.
• You can still report concerns. Nursing homes may not use an arbitration agreement to stop residents from contacting surveyors, the ombudsman or other officials.
• Don’t assume the outcome. Whether an agreement applies to a particular claim, and whether it can be enforced, are legal questions. An attorney, usually working with a medical expert on the underlying care, reviews that.

If something has already gone wrong with care, our guide on what to do after a possible medical mistake covers the first steps. Keep your documents yourself; we never ask you to send them to us. To learn what medical malpractice generally means, see medical malpractice, and to learn how our service will connect people with independent participating attorneys, see how it works.

What has changed since we first wrote about this

MalpracticeAttorneys.com first covered arbitration agreements in medical care in 2015, in an earlier article on this site. That article is no longer online. Laws and rules have changed since then, and this guide was written new from current sources checked on September 26, 2026.

Changes we verified:

• The federal nursing home rule. In a 2016 final rule, CMS prohibited nursing homes from entering into pre-dispute binding arbitration agreements with residents. A federal district court preliminarily enjoined enforcement of that prohibition on November 7, 2016. CMS then repealed the prohibition in a final rule effective September 16, 2019, and adopted the requirements described above, including the 30-day right to rescind (84 FR 34718). The provision was relettered from paragraph (n) to paragraph (m) of § 483.70 in 2024; the eCFR’s point-in-time versions show its wording unchanged since September 16, 2019.
• Sexual assault and harassment claims. Since March 3, 2022, a person alleging sexual assault or sexual harassment can choose not to be bound by a pre-dispute arbitration agreement for a related case (9 U.S.C. § 402).

Rules can keep changing. Confirm current law with an attorney licensed in your state.

Sources and corrections

We wrote this guide from the primary sources below and checked it against them on September 26, 2026.

• 9 U.S.C. § 2: Federal Arbitration Act, validity and enforcement
• 9 U.S.C. § 402: sexual assault and sexual harassment disputes
• 42 C.F.R. § 483.70(m): nursing home binding arbitration agreements
• 42 C.F.R. § 483.10(k): contact with external entities
• 84 FR 34718 (2019): CMS final rule on arbitration agreements
• Cal. Code Civ. Proc. § 1295: California medical arbitration contracts
• Fla. Stat. § 766.207: Florida voluntary binding arbitration
• Fla. Stat. § 766.106: Florida presuit notice

We are not attorneys, and this guide is not legal advice. Laws change and differ from state to state. If anything here is out of date or wrong, email support@malpracticeattorneys.com with the page name, and we’ll review it and update the page.