Introduction

7300.1 - Introduction (Rev. 213; Issued: 02-10-23; Effective: 02-10-23; Implementation: 02-10-23) These procedures are established pursuant to sections 1819(g) and 1919(g) of the Act and 42 CFR 488.330 to provide guidance about when the State or the CMS Location has the responsibility for certifying compliance or noncompliance and what procedures to follow. This section also defines the concept of “substantial compliance” for certification purposes. The State has the responsibility for certifying a skilled nursing facility’s or nursing facility’s compliance or noncompliance, except in the case of State-operated facilities. However, the State’s certification for a skilled nursing facility is subject to CMS’s approval. “Certification of compliance” means that a facility’s compliance with Federal participation requirements is ascertained. In addition to certifying a facility’s compliance or noncompliance, the State recommends appropriate enforcement actions to the State Medicaid Agency for Medicaid and to the CMS Location for Medicare. The State is authorized by CMS to both recommend and impose category 1 remedies. In addition, when authorized by the CMS Location or the State Medicaid Agency, the State may also provide notice of imposition of the denial of payment for new admissions remedy. As specified in 42 CFR 488.10, the CMS Location determines a facility’s eligibility to participate in the Medicare program based on the State’s certification of compliance and a facility’s compliance with civil rights requirements. Throughout this chapter, references are made to the State Medicaid Agency in taking enforcement actions against a Medicaid facility. However, there is nothing in Federal regulation that precludes the State Medicaid Agency from delegating the authority to act on its behalf in imposing enforcement remedies for Medicaid nursing facilities. The CMS Location has the responsibility for certifying a State-operated skilled nursing facility’s or nursing facility’s compliance or noncompliance. In accordance with §1919(h)(3), the CMS Location may take independent and binding enforcement action against any nursing facility based on its findings of noncompliance. However, the CMS Location’s certification is usually based on the State’s survey and findings.