This page provides basic information about being certified as a Medicare and/or Medicaid nursing home provider and includes links to applicable laws, regulations, and compliance information. Below in the downloads section, we also provide you related nursing home reports, compendia, and the list of special focus facilities (i.e., nursing homes with a record of poor survey (inspection) performance on which CMS focuses extra attention).
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.
Other Nursing Home related data and reports can be found in the downloads section below
New Posting - Evaluation of the Quality Indicator Survey (QIS)
The Executive Summary of the Evaluation Report of the Quality Indicator Survey (QIS) is now available for download. The QIS evaluation was funded early in the 5-State QIS pilot, and was designed to answer questions about accuracy, documentation, changes in the number and type of deficiencies, and whether the QIS process is more efficient. Improved consistency is inherently embedded into QIS processes, so this was not evaluated. The Study instead assessed whether the QIS also had beneficial effects on other aspects of the survey process, such as improving the accuracy of citations. Since the evaluation did not find improved accuracy, we conclude that non-QIS factors, including (a) survey guidance clarification, (b) training of surveyors, and (c) surveyor supervision are prudent approaches to improvement of accuracy. CMS continues to issue improved surveyor guidance as well as to strengthen surveyor training. We also concluded that future QIS development efforts should concentrate on building upon the QIS strengths relative to consistency improvement, and giving supervisors more tools to assess performance of surveyor teams.
See below for:
- Evaluation of the Quality Indicator Survey: Executive Summary
- Special Focus Facility Initiative and List - Updated April 21, 2016
- 2012 Nursing Home Action Plan
- 2013 Nursing Home Data Compendium
- 2007 Study of Paid Feeding Assistant Programs
- Evaluation of the Quality Indicator Survey: Executive Summary [PDF, 122KB]
- Special Focus Facility Background Info and List - Updated 04/21/16 [PDF, 113KB]
- 2012 Nursing Home Action Plan [PDF, 544KB]
- Nursing Home Data Compendium 2015 [PDF, 9MB]
- Chapter 7 - Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities [PDF, 891KB]
- Nursing Homes
- Nursing Home Quality Initiative
- Social Security Act Section 1819 - Opens in a new window
- Study of Paid Feeding Assistant Programs - Full Report (PDF, 1.4 MB) - Opens in a new window
- Social Security Act Section 1919 - Opens in a new window
- 42 CFR 483.350 - 483.376 - Opens in a new window
- Page last Modified: 04/27/2016 7:32 AM
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