Federal Requirements for Skilled Nursing Facility Long Term Care Facilities
Federal Requirements for Nursing Homes
There are numerous federal requirements for nursing homes some of which are set forth in the definitions of federal regulation 42 CFR § 483.5 (2). In addition to the requirements that are set forth for a long-term care facility a skilled nursing facility also known as SNF or NF. The most important of which are ownership requirements which set forth the need for an operating governing body. There is also clarification that the institution of which a SNF is a distinct part has responsibility for administrative decisions and personnel policies and other legal obligations. The statute discusses the requirement for a NFS to have an administrator as well as a medical director responsible for implementing care policies and coordinating medical care and who is directly responsible to the management of the institution.
The statute also has requirements concerning when notification to CMS is required for example when there is a change in the number of beds in the facility. There are also requirements concerning the provider agreement signed by the organization including that if there is a composite of more than one location there may only be one provider agreement.
The statute all this so requires to ensure quality of care quality of life for the residents must provide common areas such as dining rooms, activity rooms, meeting rooms where residents are located on a regular basis, and other areas of the facility were residents may gather together with other residents visitors and staff. There is also requirement that the facilities be fully sprinklered. A long-term care facility must be sprinklered in accordance with national fire protection Association 13 quote standard for the installation of sprinkler systems”
(2) Requirements. In addition to meeting the participation requirements for long-term care facilities set forth elsewhere in this subpart, a distinct part SNF or NF must meet all of the following requirements:
(i) The SNF or NF must be operated under common ownership and control (that is, common governance) by the institution of which it is a distinct part, as evidenced by the following:
(A) The SNF or NF is wholly owned by the institution of which it is a distinct part.
(B) The SNF or NF is subject to the by-laws and operating decisions of a common governing body.
(C) The institution of which the SNF or NF is a distinct part has final responsibility for the distinct part’s administrative decisions and personnel policies, and final approval for the distinct part’s personnel actions.
(D) The SNF or NF functions as an integral and subordinate part of the institution of which it is a distinct part, with significant common resource usage of buildings, equipment, personnel, and services.
(ii) The administrator of the SNF or NF reports to and is directly accountable to the management of the institution of which the SNF or NF is a distinct part.
(iii) The SNF or NF must have a designated medical director who is responsible for implementing care policies and coordinating medical care, and who is directly accountable to the management of the institution of which it is a distinct part.
(iv) The SNF or NF is financially integrated with the institution of which it is a distinct part, as evidenced by the sharing of income and expenses with that institution, and the reporting of its costs on that institution’s cost report.
(v) A single institution can have a maximum of only one distinct part SNF and one distinct part NF.
(vi) (A) An institution cannot designate a distinct part SNF or NF, but instead must submit a written request with documentation that demonstrates it meets the criteria set forth above to CMS to determine if it may be considered a distinct part.
(B) The effective date of approval of a distinct part is the date that CMS determines all requirements (including enrollment with the fiscal intermediary (FI)) are met for approval, and cannot be made retroactive.
(C) The institution must request approval from CMS for all proposed changes in the number of beds in the approved distinct part.
(c) Composite distinct part—(1) Definition. A composite distinct part is a distinct part consisting of two or more noncontiguous components that are not located within the same campus, as defined in §413.65(a)(2) of this chapter.
(2) Requirements. In addition to meeting the requirements of paragraph (b) of this section, a composite distinct part must meet all of the following requirements:
(i) A SNF or NF that is a composite of more than one location will be treated as a single distinct part of the institution of which it is a distinct part. As such, the composite distinct part will have only one provider agreement and only one provider number.
(ii) If two or more institutions (each with a distinct part SNF or NF) undergo a change of ownership, CMS must approve the existing SNFs or NFs as meeting the requirements before they are considered a composite distinct part of a single institution. In making such a determination, CMS considers whether its approval or disapproval of a composite distinct part promotes the effective and efficient use of public monies without sacrificing the quality of care.
(iii) If there is a change of ownership of a composite distinct part SNF or NF, the assignment of the provider agreement to the new owner will apply to all of the approved locations that comprise the composite distinct part SNF or NF.
(iv) To ensure quality of care and quality of life for all residents, the various components of a composite distinct part must meet all of the requirements for participation independently in each location.
(d) Common area. Common areas are dining rooms, activity rooms, meeting rooms where residents are located on a regular basis, and other areas in the facility where residents may gather together with other residents, visitors, and staff.
(e) Fully sprinklered. A fully sprinklered long term care facility is one that has all areas sprinklered in accordance with National Fire Protection Association 13 “Standard for the Installation of Sprinkler Systems” without the use of waivers or the Fire Safety Evaluation System.
If you If you are concerned family members suffered from preventable abuse or neglect while they were a resident of a nursing home skilled nursing facility or other long-term care facility including assisted living or home care provider please feel free to contact attorney Kenneth LaBore for a free consultation he can be reached by phone at 612-743-9048 or at 1-888-452-6589. Ken LaBore has been handling nursing home and abuse cases for years and has helped hundreds of families negligent care providers accountable. You can also reach Mr. LaBore by e-mail at KLaBore@MNnursinghomeneglect.com