Definitions and Acronyms

7001 - Definitions and Acronyms (Rev. 244; Issued: 06-26-26; Effective: 06-26-26; Implementation: 06-26-26) Abbreviated Standard Survey means a survey other than a standard survey that gathers information primarily through resident-centered techniques on facility compliance with the requirements for participation. An abbreviated standard survey may be premised on complaints received; a change in ownership, management, or director of nursing; or other indicators of specific concern. (42 CFR 488.301)NOTE: Abbreviated standard surveys may also be referred to as complaint investigations. Abuse - The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. (42 CFR 483.5) Act - the Social Security Act CASPER - Certification and Survey Provider Enhanced Reporting. Certification of Compliance means that the facility is in at least substantial compliance and is eligible to participate in Medicaid as a nursing facility, or in Medicare as a skilled nursing facility, or in both programs as a dually participating facility. Certification of Noncompliance means that the facility is not in substantial compliance and is not eligible to participate in Medicaid as a nursing facility, or in Medicare as a skilled nursing facility, or in both programs as a dually participating facility. CFR - Code of Federal Regulations. CMP - Civil Money Penalty. CMPTS - Civil Money Penalty Tracking System. CMS - Centers for Medicare & Medicaid Services. Deficiency means a skilled nursing facility’s or nursing facility’s failure to meet a participation requirement specified in the Act or in 42 CFR Part 483 Subpart B. (42 CFR 488.301) DoPNA or DPNA - Denial of Payment for New Admissions. DPoC - Directed Plan of Correction. Dually Participating Facility means a facility that has a provider agreement in both the Medicare and Medicaid programs. Educational programs mean programs that include any subject pertaining to the long- term care participation requirements, the survey process, or the enforcement process. Enforcement action means the process of imposing one or more of the following remedies: termination of a provider agreement; denial of payment for new admissions; denial of payment for all residents; temporary manager; civil money penalty; State monitoring; directed plan of correction; directed in-service training; transfer of residents; closure of the facility and transfer of residents; or other CMS-approved alternative State remedies. Expanded survey means an increase beyond the core tasks of a standard survey. A standard survey may be expanded at the surveying entity’s discretion. When surveyors suspect substandard quality of care (SQC), they should expand the survey to determine if SQC does exist. Extended survey means a survey that evaluates additional participation requirements subsequent to finding SQC during a standard survey. (42 CFR 488.301) Facility means a skilled nursing facility (SNF) that meets the requirements of sections 1819(a), (b), (c), and (d) of the Act, or a nursing facility (NF) that meets the requirements of sections 1919(a), (b), (c), and (d) of the Act. “Facility” may include a distinct part of an institution (as defined in §483.5 and specified in §440.40 and §440.155) but does not include an institution for individuals with intellectual disabilities or persons with related conditions described in §440.150 of this chapter. For Medicare and Medicaid purposes (including eligibility, coverage, certification, and payment), the “facility” is always the entity that participates in the program, whether that entity is comprised of all, or a distinct part of, a larger institution. For Medicare, a SNF, and for Medicaid, a NF may not be an institution for mental diseases as defined in §435.1010 of this chapter. (42 CFR 483.5) FSES – Fire Safety Evaluation System. IDR – Informal Dispute Resolution. Immediate family as defined in 42 CFR 488.301 means a husband or wife; natural or adoptive parent, child or sibling; stepparent, stepchild, stepbrother, or stepsister; father- in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild. NOTE: see guidance at tag F563 in Appendix PP under Resident Rights §483.10(f)(4)(ii)-(v) – “For purposes of this regulation, immediate family is not restricted to individuals united by blood, adoptive, or marital ties, or a State’s common law equivalent. It is important to understand that there are many types of families, each of which being equally viable as a supportive, caring unit. For example, it might also include a foster family where one or more adult serves as a temporary guardian for one or more children to whom they may or may not be biologically related. Residents have the right to define their family.” Immediate Jeopardy (IJ) means a situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident. (42 CFR 488.301) IIDR – Independent Informal Dispute Resolution Instance or instances of noncompliance means a factual and temporal occurrence(s) when a facility is not in substantial compliance with the requirements for participation. Each instance of noncompliance is sufficient to constitute a deficiency and a deficiency may comprise of multiple instances of noncompliance. (42 CFR 488.401) IQIES - Internet Quality Improvement and Evaluation System LSC – Life Safety Code. MAC means - Medicare Area Contractor. Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent. (42 CFR 488.301) NATCEP – Nurse Aide Training and Competency Evaluation Program. Neglect means failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. (42 CFR 483.5) New admission, for purposes of a denial of payment remedy, new admission means a resident who is admitted to the facility on or after the effective date of a denial of payment remedy and, if previously admitted, has been discharged before that effective date. Residents admitted before the effective date of the denial of payment, and taking temporary leave, are not considered new admissions, nor subject to the denial of payment. (42 CFR 488.401) (See §7506 for examples of what does and does not constitute a new admission for purposes of the remedy.) Noncompliance means any deficiency that causes a facility not to be in substantial compliance. (42 CFR 488.301) Noncompliance cycle - See 7317.3 for definition. No Opportunity to Correct (NOTC) means the facility will have remedies imposed immediately after a determination of noncompliance has been made. Nurse aide means any individual providing nursing or nursing-related services to residents in a facility. This term may also include an individual who provides these services through an agency or under a contract with the facility, but is not a licensed health professional, a registered dietitian, or someone who volunteers to provide such services without pay. Nurse aides do not include those individuals who furnish services to residents only as paid feeding assistants as defined in 42 CFR §488.301. (42 CFR 483.5) Opportunity to Correct (OTC) means the facility is allowed an opportunity to correct identified deficiencies before remedies are imposed. Partial extended survey means a survey that evaluates additional participation requirements subsequent to finding SQC during an abbreviated standard survey. (42 CFR 488.301.) Past Noncompliance (PNC) means a deficiency citation at a specific survey data tag (F- tag or K-tag), that meets all of the following three criteria: 1) The facility was not in compliance with the specific regulatory requirement(s) (as referenced by the specific F-tag or K-tag) at the time the situation occurred; 2) The noncompliance occurred after the exit date of the last standard (recertification) survey and before the survey (standard, complaint, or revisit) currently being conducted, and 3) There is sufficient evidence that the facility corrected the noncompliance and is in substantial compliance at the time of the current survey for the specific regulatory requirement(s), as referenced by the specific F-tag or K-tag. Per day civil money penalty means a civil money penalty imposed for the number of days a facility is not in substantial compliance. Per instance civil money penalty means a civil money penalty imposed for each instance of facility noncompliance. Plan of Correction (PoC) means a plan developed by the facility and approved by CMS or the State agency that describes the actions the facility will take to correct deficiencies and specifies the date by which those deficiencies will be corrected. (42 CFR 488.401) QIES - Quality Improvement and Evaluation System. Resident Representative or Representative - means any of the following: (1) An individual chosen by the resident to act on behalf of the resident in order to support the resident in decision-making; access medical, social or other personal information of the resident; manage financial matters; or receive notifications; (2) A person authorized by State or Federal law (including but not limited to agents under power of attorney, representative payees, and other fiduciaries) to act on behalf of the resident in order to support the resident in decision-making; access medical, social or other personal information of the resident; manage financial matters; or receive notifications; or (3) Legal representative, as used in section 712 of the Older Americans Act; or (4) The court-appointed guardian or conservator of a resident. (5) Nothing in this rule is intended to expand the scope of authority of any resident representative beyond that authority specifically authorized by the resident, State or Federal law, or a court of competent jurisdiction. (42 CFR 483.5) Self-Reported Noncompliance- Noncompliance that is reported by a facility to the State Agency before it is identified by the State, CMS, or reported to the State or CMS by an entity other than the facility itself. SFF – Special Focus Facility. Skilled nursing facility (SNF) means a Medicare-certified nursing facility that has a Medicare provider agreement. (42 CFR 488.301) Standard survey (Also known as a recertification survey) means a periodic, resident- centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation. (42 CFR 488.301) State agency (SA) means the entity responsible for conducting most surveys to certify compliance with the Centers for Medicare and Medicaid Services’ participation requirements. State Medicaid Agency (SMA) means the entity in the State responsible for administering the Medicaid program. Substandard Quality of Care (SQC) means one or more deficiencies related to participation requirements under 42 CFR 483.10 “Resident rights”, paragraphs (a)(1) through (a)(2), (b)(1) through (b)(2), (e) (except for (e)(2), (e)(7), and (e)(8)), (f)(1) through (f)(3), (f)(5) through (f)(8), and (i); § 483.12 “Freedom from abuse, neglect, and exploitation”; § 483.24 “Quality of life”; § 483.25 “Quality of care”; § 483.40 “Behavioral health services”, paragraphs (b) and (d); § 483.45 “Pharmacy services”, paragraphs (d), (e), and (f); § 483.70 “Administration”, paragraph (p), and § 483.80 “Infection control”, paragraph (d), which constitute either immediate jeopardy to resident health or safety; a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm. (42 CFR 488.301) Substantial compliance means a level of compliance with the requirements of participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm. (42 CFR 488.301) Substantial compliance constitutes compliance with participation requirements.