Physician Delegation of Tasks in Skilled Nursing Facilities (SNFs) and
Nursing Facilities (NFs)
This memorandum replaces Survey and Certification memorandum S&C-04-08 dated
November 13, 2003, which discusses physician delegation of tasks in SNFs and NFs.
Guidance revision: This memo provides clarification of Federal guidance related
to physician delegation of certain tasks in SNFs and NFs to non-physician practitioners (NPPs;
formerly “physician extenders”) such as nurse practitioners, physician assistants, or clinical
Implements Section 3108 of the Affordable Care Act (ACA): Implements section
3108 of the Affordable Care Act, which adds physician assistants to the list of practitioners that
can perform Skilled Nursing Facility (SNF) level of care
certifications and re-certifications.
Co-signing of orders: Clarifies policy on co-signing orders in SNFs and NFs.