Introduction

7000 - Introduction (Rev. 213; Issued: 02-10-23; Effective: 02-10-23; Implementation: 02-10-23) Chapter 7 implements the nursing home survey, certification, and enforcement regulations at 42 CFR Part 488. No provisions contained in this chapter are intended to create any rights or remedies not otherwise provided in law or regulation. The nursing home reform regulation establishes several expectations. The first is that providers remain in substantial compliance with Medicare/Medicaid program requirements as well as State law. The regulation emphasizes the need for continued, rather than cyclical compliance. The enforcement process mandates that policies and procedures be established to remedy deficient practices and to ensure that correction is lasting; specifically, that facilities take the initiative and responsibility for continuously monitoring their own performance to sustain compliance. Measures such as the requirements for an acceptable plan of correction emphasize the ability to achieve and maintain compliance leading to improved quality of care. (See §7304.4 for plan of correction requirements.) The second expectation is that all deficiencies will be addressed promptly. The standard for program participation mandated by the regulation is substantial compliance. The State and the Centers for Medicare and Medicaid Services (CMS) Location will take steps to bring about compliance quickly. In accordance with §7304, remedies such as civil money penalties, temporary managers, directed plans of correction, in-service training, denial of payment for new admissions, and State monitoring can be imposed before a facility has an opportunity to correct its deficiencies. The third expectation is that residents will receive the care and services they need to meet their highest practicable level of functioning. The process detailed in these sections provides incentives for the continued compliance needed to enable residents to reach these goals. It should be noted that references to the State would be applicable, as appropriate, to the CMS Location throughout this chapter when the CMS Location is the surveying entity. It should also be noted that in cases where the State is authorized by CMS and/or the State Medicaid Agency, the State may provide notice of imposition of certain remedies on their behalf, within applicable notice requirements. It should be noted that failure of CMS or the State to act timely does not invalidate otherwise legitimate survey and enforcement determinations. The ASPEN Enforcement Manager (AEM) is the data system used by CMS and all States for data entry and reporting on nursing home survey and enforcement activities.