Initial Survey and Certification Responsibility

7300.3 - Initial Survey and Certification Responsibility (Rev. 213; Issued: 02-10-23; Effective: 02-10-23; Implementation: 02-10-23) The State determines whether a prospective provider is in substantial compliance with the nursing home participation requirements. If the facility is in substantial compliance, the State certifies and recommends that the CMS Location and/or State Medicaid Agency enter into an agreement with the facility. Using the guidance below about the methods by which substantial compliance may be determined, if the facility is determined not to be in substantial compliance, the State recommends that the CMS Location and/or State Medicaid Agency deny participation. The CMS Location and/or State Medicaid Agency sends the letter notifying the facility of its denial of participation in the Medicare and/or Medicaid programs, and includes the appeal rights available under 42 CFR 431.153 and 42 CFR 498.3(b). (See also §2005 and §7203 of this manual.) With the exception of an initial survey for reasonable assurance, if the initial survey of the prospective provider finds that the noncompliance is such that the deficiencies fall at levels D, E, or F (without a finding of substandard quality of care) on the scope and severity scale, the State survey agency may opt to accept evidence of correction to confirm substantial compliance in lieu of an onsite revisit; however, the State survey agency always has the discretion to conduct an onsite revisit to determine if corrections have been made. If the noncompliance falls at level F (with a finding of substandard quality of care), or any level higher than level F, the option to accept evidence of correction in lieu of an onsite revisit does not apply. In this case, an onsite revisit is necessary to determine substantial compliance after the facility submits an acceptable plan of correction. For reasonable assurance, deficiencies at level D or above on the first survey will result in denial for purposes of starting Medicare reasonable assurance. (See §7321.3.1.) The plan of correction does not assure the execution of a provider agreement. The effective date of the provider agreement would be the date the survey agency verifies substantial compliance as determined by the appropriate evidence of correction as discussed above. With the exception of an initial survey for reasonable assurance, the option to accept evidence of correction in lieu of an onsite revisit is also applicable when an existing Medicaid nursing facility with deficiencies at levels D, E, or F (without substandard quality of care) wishes to participate as a Medicare skilled nursing facility. The survey agency does not conduct a new survey. The survey agency submits the information obtained during the most recent Medicaid survey and other documentation as required, e.g., compliance with 42 CFR 483.30(c) and (d) and 42 CFR 483.40(e) and (f), for the initial certification of the Medicare nursing home to the CMS Location. The Medicare provider agreement would be effective when the survey agency determines the facility is in substantial compliance either through evidence of correction submitted or by an onsite revisit. For reasonable assurance, deficiencies at level D or above on the first survey will result in denial for purposes of starting Medicare reasonable assurance. (See §7321.3.1.) When the State recommends that the CMS Location and/or State Medicaid Agency deny participation, the CMS Location and/or State Medicaid agency sends the letter notifying the facility of its denial of participation in the Medicare and/or Medicaid programs, and includes the appeal rights available under 42 CFR 431.153 and 42 CFR 498.3(b).