Note: On Oct. 27, 2017, CMS issued a draft update to Chapter 7 via survey-and-certification memo 18-01-NH. This draft does not have an effective/implementation date and could change prior to the release of the final version. It addresses proposed changes to the immediate imposition of federal remedies.
Chapter 7, "Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities," is the core "how to" chapter of the State Operations Manual for nursing home surveys and enforcement actions by state agencies. The chapter opens with definitions of a skilled nursing facility and a nursing facility, and explains special waivers that may apply to SNFs and NFs, such as a waiver of the seven-day RN Requirement for SNFs. In addition, this chapter covers:
The survey process. Topics in these sections include but are not limited to:
The size and composition of the survey team, as well as survey frequency and timing;
- The survey protocol for different survey types, including initial certifications, resurveys, abbreviated standard surveys, and state monitoring visits;
- The rules for substandard quality of care and extended and partial extended surveys;
- Informal dispute resolution and independent informal dispute resolution;
- Actions to be taken when a facility is not in substantial compliance, including when immediate jeopardy exists;
- Provider appeal of a certification of noncompliance;
- Acceptable plans of correction;
- State survey agency notice requirements in various scenarios;
- Enforcement actions and appropriate timing of those actions when immediate jeopardy exists or does not exist; and
- The rules for readmitting a SNF or dually participating facility to Medicare or Medicaid after termination.
The enforcement process. Topics in these sections include but are not limited to:
- A listing of potential enforcement remedies and mandatory enforcement remedies;
- Factors surveyors should use when selecting remedies; and
- Life Safety Code enforcement guidelines.
Remedies. Topics in these sections include but are not limited to:
- A directed plan of correction;
- Directed inservice training;
- State monitoring;
- Denial of payment for all New Medicare and Medicaid admissions; and
- Denial of payment for all Medicare and Medicaid residents.
Civil money penalties. Topics in these sections include but are not limited to:
- How the amount of a CMP should be determined;
- The duration of a CMP;
- When a CMP is due and payable;
- The rules for temporary management; and
- Termination procedures when a facility isn't in substantial compliance.
Program management. Topics in these sections include but are not limited to:
- Consistency of state survey results;
- State/federal disagreements about timing and choice of remedies; and
- Nurse aide training and competency evaluation program and competency evaluation program disapprovals.
Disclosure. Topics in these sections include but are not limited to:
- Time periods for disclosing SNF/NF information;
- Information that must be given to the long-term care ombudsman; and
- Information that must be furnished to the state by facilities with substandard quality of care.