Nursing homes participating in Medicare and Medicaid are required by federal law to undergo an annual survey and certification process by its state’s health department. Homes must be in substantial compliance with Medicare and Medicaid requirements, as well as state law.
Nursing home regulations require each facility to have its latest survey results readily available for review. The survey assesses whether the quality of care, as intended by the law and regulations and as needed by the resident, is being provided in the nursing home.
If a nursing home is found to be violating nursing home regulations, federal law enforcement options include denying payment for new admissions, fining the home, revoking Medicaid and Medicare certifications, transferring residents, and imposing temporary management.
The survey and certification process establishes several expectations of nursing homes, including:
- Nursing homes participating in Medicare and Medicaid programs must remain in substantial compliance with the Medicaid/Medicare care requirements
- All deficiencies will be addressed promptly
- Residents will receive the care and services they need to meet their highest practicable level of functioning
If the annual certification survey finds a nursing home is deficient because it doesn’t meet a requirement of the federal nursing home regulations, the deficiency is recorded in a Survey Report Form. Deficiencies alleged by staff, residents or family members must be confirmed through records, interviews and observations. If staff, resident or family allegations are not confirmed through records, interviews, or observations, the nursing home cannot be cited as deficient. Once a survey team determines that deficiencies exist, it decides the seriousness of the violations. It looks at whether the deficiency status constitutes immediate jeopardy or actual harm, as well as whether the deficiency is isolated, constitutes a pattern or is widespread.
The Medicare website lists the most recent federal survey results, populations of the nursing homes surveyed and facts about nursing homes’ ownership. It can be a valuable resource when selecting a nursing home for your loved one.