Licensing and Certification

Each state has an Office of Licensure and Certification that works to ensure that the quality of healthcare delivered by providers is safe, cost effective and compliant with all state and federal laws. Nursing homes must be licensed to operate according to their state’s licensure requirements.

The Centers for Medicare and Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency which administers Medicare, Medicaid, and the Children’s Health Insurance Program. CMS is also the agency responsible for enforcing quality standards in nursing homes through its survey and certification process. Those nursing homes wishing to receive reimbursement from Medicare and/or Medicaid must also be certified by the state that they are in compliance with the requirements of the Nursing Home Reform Act regulations (found at 42 CFR Part 483, Subpart B).

Consumer Information


Nursing Home Compare
Nursing Home Compare allows consumers to compare information about nursing homes. It contains quality of care information on every Medicare and Medicaid-certified nursing home in the country, including over 15,000 nationwide.  Note: Nursing homes aren't included on Nursing Home Compare if they aren't certified to participate in Medicare or Medicaid. These Nursing Homes can be licensed by the state.

Five-Star Quality Rating System
CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

Nursing Home Survey and Enforcement Process


State Operations Manual (SOM)
When Congress passed the Nursing Home Reform Act in 1987, it issued a clear set of standards that nursing homes had to meet in order to receive federal funding under Medicare and Medicaid. Regulations were written based on the requirements of the law and a State Operations Manual (SOM) was developed issuing the protocols for overseeing implementation of the regulations and to provide guidance to surveyors of long-term care facilities on interpreting the requirements.  The SOM is linked below.

The Interpretive Guidelines: A Tool for Advocacy (September 2012)
The guidance to surveyors, Appendix PP - Guidance to Surveyors of Long-Term Care Facilities, often called the Interpretive Guidelines, can be an important tool for advocates promoting quality in long-term care facilities.  This resource details how you can use the Interpretive Guidelines in your advocacy efforts.

Evaluation of the Quality Indicator Survey (QIS) (December 2007)

Supporting the Ombudsman's New Role in the Long-Term Care Survey Process (October 1991)
Surveyors are instructed to seek information from ombudsmen about their experiences at the nursing home and to invite ombudsmen to the survey exit conference. This technical assistance brief details the extent of the ombudsman role in the survey process.

CMS Surveyor Training
Online training by CMS for surveyors, includes webcasts, web-based training, and modules on Reduction in Unnecessary Medications in Nursing Homes.
 

CMS Survey and Certification Letters


Installation of Automatic Sprinkler Systems in Nursing Homes - August 13, 2013 Deadline (REVISED December 2013)

Escrow and Independent Informal Dispute Resolution (Independent IDR) Process for Nursing Homes – Applicable to All Civil Money Penalties (CMPs) - August 2013

FY2013 Sequestration Adjustments for Survey & Certification (S&C) - April 2013

Use of Civil Money Penalty (CMP) Funds by States

Guidance for State Consumer- Oriented Websites - September 2011

State Websites that Post Survey Information
Click on the resource above for a list of state websites that post inspection results from complaint surveys.

GAO Studies


Poorly Performing Nursing Homes: Special Focus Facilities Are Often Improving, but CMS’s Program Could Be Strengthened, U.S. Government Office of Accountability (March 2010)

Resources


2012 Nursing Home Action Plan

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