Medicare State Operations Manual



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State Operations Manual
Chapter 7 - Survey and Enforcement Process for Skilled
Nursing Facilities and Nursing Facilities
(Rev. 185, 11-16-18)

Table of Contents
Transmittals for Chapter 7

7000 - Introduction - Definitions and Acronyms - Change in Certification Status for Medicaid Nursing Facilities - Skilled Nursing Facility - Citations and Description - Citations - Description of Skilled Nursing Facility - Nursing Facility - Citations and Description - Citations - Description of Nursing Facility - Types of Facilities That May Qualify as Skilled Nursing Facilities and Nursing Facilities - Skilled Nursing Facilities Providing Outpatient Physical Therapy, Speech Pathology, or Occupational Services - Reserved - Special Waivers Applicable to Skilled Nursing Facilities and Nursing Facilities - Waiver of Nurse Staffing Requirements - Waiver of Day Registered Nurse (RN) Requirement for Skilled Nursing Facilities - Waivers of Nurse Staffing Requirements in Nursing Facilities - Waivers of Nurse Staffing Requirements for Dually Participating Facilities - Initial Requests for Nurse Waiver - Waiver of Life Safety Code - Variations of Patient Room Size and/or Beds Per Room - Documentation to Support Waivers or Variations


Survey process
Enforcement process
Civil money penalties
Program management
Act - the social security act aem -
Dopna orb dpnab - denial of payment for new admissions. dpoc -
Fses – fire safety evaluation system. idr
Independent idr –
Partial extended survey
Per day civil money penalty
Self-reported noncompliance-
State survey agency (sa)
Substantial compliance
Therapy, speech pathology, or occupational services
Participating facilities
Evaluation program or competency evaluation program when entity
Surveys (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Competency evaluation program
Dispute cited deficiencies after a survey
Situation eligibility for informal dispute
Process (rev. 118, issued 06-12-14, effective 01-01-12, implementation 01-01-12)
Situation eligibility for independent
Opportunity to comment:
Entity or persons)
Independence: the entity or person –
Dispute resolution process
Nursing facilities and nursing facilities
Non-state operated skilled nursing facilities
Mandatory immediate imposition of federal remedies
Use of federal remedies in immediate jeopardy (ij) citations -
Directed plan of correction -
Denial of payment for all new medicare and medicaid admissions (dpna) -
Denial of all payment for all medicare and medicaid residents (dpaa)
State monitoring
Termination of provider agreement -
For immediate jeopardy
Notices when remedies are imposed
Note: in order fora day termination to be stopped, the ij must be removed, even
Calendar day
Day (rev. 185, issued 11-16-18, effective 11-16-18, implementation 11-16-18)
Impose remedies when immediate jeopardy does not exist
Immediate jeopardy
Imposition and rescission of category 1 remedies and denial of
Not exist (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Plan of correction
Revisit/date of compliance policy
Complaint surveys
Life safety code surveys
Visits to special focus facilities
Repeated substandard quality of care
Readmission to medicare or medicaid program after termination
Example 1: nursing home a
The termination -
Reasonable assurance decision -
Example 2: nursing home b.
Remedies (rev. 185, issued 11-16-18, effective 11-16-18, implementation 11-16-18)
Facilities and nursing facilities
Level 4 - immediate jeopardy to resident health or safety:
Denial of payment for new admissions
Programs (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Admissions for skilled nursing facilities and nursing facilities
Medicaid residents
Upper range of penalty amounts for per day civil money penalty
Decreasing per day civil money penalty range
Repeated deficiencies
Reporting and prompt correction of noncompliance
Selected (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Penalty (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Cms imposes civil money penalty
State imposes civil money penalty.
Medicare facility.
Medicaid facility.
Purpose and summary
Consumer and other stakeholder involvement
Contacts: name of the state contact person responsible for the project and contact information. note:
Civil money penalty funds from the state
When civil money penalty of $5,000 or more is assessed
Facility (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Participation requirements
Plan of correction and has achieved substantial compliance
Approved plan of correction and has not achieved substantial
Correction but fails to achieve substantial compliance
Rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Temporary management
Remedies (rev. 63, issued 09-10-10, effective 09-10-10, implementation 09-10-10)
Competency evaluation program disapprovals
Competency evaluation program or competency evaluation program
Disclosure 7900 - information disclosed to public
Facility information
Rev # issue date



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