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. In the downloads section, we also provide you related nursing home reports, compendia, and the list of Special Focus Facilities (SFF) (i.e., nursing homes with a record of poor survey (inspection) performance on which CMS focuses extra attention). SFF archives include lists from March 2008.
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, a Standard Health Survey, and an Emergency Preparedness 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 is responsible 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 appropriate CMS Location for Medicare.
The CMS Location 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 CMS Location 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 CMS Location 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 CMS Location for the skilled nursing facility. In the case where the State and the CMS Location 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.
See below for:
- Special Focus Facility Initiative and List - January 31, 2024
Chapter 7 - Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities (PDF)