In 1990, Congress passed The Patient SelfDetermination Act (PSDA) 42 U.S.C. §§ 1395 et seq., a federal law which requires health care providers (that are recipients of federal Medicaid/Medicare funds) to inform all adult patients of their right to accept or refuse medical treatment, and their right to execute an advance directive. This law had particular impact upon nursing homes and assisted living facilities, because it required them to ask each /patient/ resident whether an advance directive was in effect, and if not, if he or she desired one.