Government Regulation of Nursing Homes

Skilled nursing facilities (SNFs) and nursing facilities (NFs) are required to be in compliance with the requirements in 42 CFR Part 483, Subpart B, to receive payment under the Medicare or Medicaid programs.  To certify a SNF or NF, a state surveyor completes at least a Life Safety Code (LSC) survey, and a Standard Survey.

SNF/NF surveys are not announced to the facility.  States conduct standard surveys and complete them on consecutive workdays, whenever possible.  They may be conducted at any time including weekends, 24 hours a day.  When standard surveys begin at times beyond the business hours of 8:00 a.m. to 6:00 p.m., or begin on a Saturday or Sunday, the entrance conference and initial tour should is modified in recognition of the residents’ activity (e.g., sleep, religious services) and types and numbers of staff available upon entry.

The State has the responsibility for certifying a skilled nursing facility’s or nursing facility’s compliance or noncompliance, except in the case of State-operated facilities.  However, the State’s certification for a skilled nursing facility is subject to CMS’ approval.  “Certification of compliance” means that a facility’s compliance with Federal participation requirements is ascertained.  In addition to certifying a facility’s compliance or noncompliance, the State recommends appropriate enforcement actions to the State Medicaid agency for Medicaid and to the regional office for Medicare.

The CMS regional office determines a facility’s eligibility to participate in the Medicare program based on the State’s certification of compliance and a facility’s compliance with civil rights requirements.

The following entities are responsible for surveying and certifying a skilled nursing facility’s or nursing facility’s compliance or noncompliance with Federal requirements:

• State-Operated Skilled Nursing Facilities or Nursing Facilities or State-Operated Dually Participating Facilities – The State conducts the survey, but the regional office certifies compliance or noncompliance and determines whether a facility will participate in the Medicare or Medicaid programs.
• Non-State Operated Skilled Nursing Facilities – The State conducts the survey and certifies compliance or noncompliance, and the regional office determines whether a facility is eligible to participate in the Medicare program.
• Non-State Operated Nursing Facilities – The State conducts the survey and certifies compliance or noncompliance.  The State’s certification is final.  The State Medicaid agency determines whether a facility is eligible to participate in the Medicaid program.
• Non-State Operated Dually Participating Facilities (Skilled Nursing Facilities/Nursing Facilities) – The State conducts the survey and certifies compliance or noncompliance.  The State’s certification of compliance or noncompliance is communicated to the State Medicaid agency for the nursing facility and to the regional office for the skilled nursing facility.  In the case where the State and the regional office disagree with the certification of compliance or noncompliance, there are certain rules to resolve such disagreements.

Source: //www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs.html