Requirements for States and Long Term Care Facilities

Basis and scope.

This provision outlines the statutory basis and scope for participation of skilled nursing facilities and nursing facilities in Medicare and Medicaid programs.

Resident rights.

This regulation establishes the fundamental rights of residents in long-term care facilities, including rights to dignity, self-determination, communication, care planning, privacy, and grievance resolution.

Basis.

This provision establishes the statutory basis for state responsibilities regarding preadmission screening and annual resident review for individuals with mental illness or intellectual disability.

Applicability and definitions.

This provision defines the scope of PASARR applicability and provides clinical criteria for identifying serious mental illness and intellectual disability.

State plan requirement.

This provision mandates that states operate a preadmission screening and annual resident review program as a condition of Medicaid State plan approval.

Basic rule.

This provision details the requirements for preadmission screening, annual reviews, and exemptions for hospital discharges.

Relationship of PASARR to other Medicaid processes.

This provision clarifies that PASARR determinations cannot be countermanded by Medicaid agencies and must be coordinated with routine resident assessments.

Out-of-State arrangements.

This provision specifies that the state of residence is responsible for PASARR costs and determinations, even for out-of-state facility placements.

Preadmission screening of applicants for admission to NFs.

This provision outlines the requirements for determining the need for nursing facility services and specialized services for applicants with mental illness or intellectual disability.

Annual review of NF residents.

This provision mandates annual reviews for nursing facility residents with mental illness or intellectual disability to determine the continued need for services.

Residents and applicants determined to require NF level of services.

This provision specifies that facilities may admit or retain individuals determined to need nursing facility services and requires the state to arrange specialized services if needed.

Residents and applicants determined not to require NF level of services.

This provision outlines the requirements for state authorities and nursing facilities regarding the discharge, orientation, and specialized service arrangements for residents or applicants who do not meet the criteria for nursing facility level of care.

Freedom from abuse, neglect, and exploitation.

The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.

Specialized services.

This provision defines specialized services for individuals with mental illness or intellectual disabilities and mandates that nursing facilities provide or arrange for these services when necessary.

FFP for NF services.

This provision establishes the conditions under which federal financial participation is available for nursing facility services based on preadmission screening and annual review requirements.

FFP for specialized services.

This provision clarifies that federal financial participation is not available for specialized services when they are furnished to nursing facility residents as part of standard nursing facility services.

Appropriate placement.

This provision sets the criteria for determining the appropriateness of placing an individual with mental illness or intellectual disability in a nursing facility based on their treatment needs.

PASARR evaluation criteria.

This provision details the Preadmission Screening and Resident Review (PASARR) evaluation criteria, including identification, interdisciplinary coordination, and reporting requirements for individuals with mental illness or intellectual disabilities.

PASARR determination criteria.

This provision establishes the criteria for Preadmission Screening and Resident Review (PASARR) determinations, including categorical assessments, notice requirements, and placement options for individuals with mental illness or intellectual disabilities entering or residing in nursing facilities.

Evaluating the need for NF services and NF level of care (PASARR/NF).

This provision outlines the requirements for evaluating whether an individual with mental illness or intellectual disability requires nursing facility level of care or an alternative setting.

Evaluating whether an individual with mental illness requires specialized services (PASARR/MI).

This provision establishes the data collection and personnel requirements for state mental health authorities to determine if an individual with mental illness needs specialized services.

Evaluating whether an individual with intellectual disability requires specialized services (PASARR/IID).

This provision details the data collection and assessment criteria for state intellectual disability authorities to determine if an individual requires continuous specialized services.

Maintenance of services and availability of FFP.

This provision prohibits the termination or reduction of services during a transfer or discharge notice period and clarifies the availability of federal financial participation for those services.

Admission, transfer, and discharge rights.

This provision establishes mandatory requirements for nursing facilities regarding resident admission policies, criteria and procedures for transfer and discharge, notice requirements, and bed-hold and readmission policies.

Statutory basis; Deemed meeting or waiver of requirements.

This provision establishes the statutory authority for nurse aide training and competency evaluation programs and outlines criteria for deemed compliance and state-granted waivers.

State review and approval of nurse aide training and competency evaluation programs.

This provision details the state's role in reviewing, approving, and withdrawing nurse aide training programs, including facility-based program restrictions and waiver processes.

Requirements for approval of a nurse aide training and competency evaluation program.

This provision mandates minimum training hours, curriculum content, instructor qualifications, and prohibitions on charging nurse aides for training costs.

Nurse aide competency evaluation.

This provision outlines the requirements for nurse aide competency evaluations, including examination content, skills demonstration, administration, and proctoring standards.

Registry of nurse aides.

This provision mandates the establishment and maintenance of a nurse aide registry, including content requirements, disclosure rules, and procedures for reporting abuse or neglect.

FFP for nurse aide training and competency evaluation.

This provision specifies the conditions under which Federal Financial Participation is available for state expenditures related to nurse aide training and competency evaluation programs.

Requirements for training of paid feeding assistants.

This provision establishes the minimum training course content for paid feeding assistants and requires facilities to maintain records of trained individuals.

Resident assessment.

The facility must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity.

Statutory basis.

This provision identifies the statutory authority for the appeals process regarding discharge or transfer from skilled nursing or nursing facilities.

Definitions.

This provision defines key terms such as discharge, transfer, resident, and individual for the purposes of discharge and transfer appeal regulations.

Provision of a hearing and appeal system.

This provision requires states to provide a hearing and appeal system for residents facing discharge or transfer and for individuals affected by PASARR determinations.

Transfers, discharges and relocations subject to appeal.

This provision clarifies which transfers, discharges, and relocations are subject to appeal rights for residents in certified facilities.

Comprehensive person-centered care planning.

This provision mandates the development and implementation of baseline and comprehensive person-centered care plans and discharge planning processes for residents.

Quality of life.

Quality of life is a fundamental principle that applies to all care and services provided to facility residents.

Quality of care.

Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents.

Physician services.

This provision establishes requirements for physician supervision, visit frequency, emergency availability, and the delegation of tasks to other qualified practitioners.

Specification of resident assessment instrument.

This provision outlines the requirements for state-specified resident assessment instruments, including the Minimum Data Set, data transmission, and protection of resident-identifiable data.

Nursing services.

The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psyc...

Basis and scope.

This provision defines the statutory basis and regulatory scope for requirements regarding the use of restraint and seclusion in psychiatric residential treatment facilities for individuals under age 21.

Definitions.

This provision defines key terms related to restraint, seclusion, and emergency safety interventions for psychiatric residential treatment facilities.

General requirements for psychiatric residential treatment facilities.

This provision mandates that psychiatric residential treatment facilities comply with specific federal requirements for inpatient psychiatric services.

Protection of residents.

This provision establishes resident rights regarding restraint and seclusion, including policy notification and emergency safety intervention standards.

Orders for the use of restraint or seclusion.

This provision outlines the requirements for ordering, documenting, and assessing residents during the use of restraint or seclusion.

Consultation with treatment team physician.

This provision requires consultation with the resident's treatment team physician when restraint or seclusion is ordered by another practitioner.

Monitoring of the resident in and immediately after restraint.

This provision mandates continuous monitoring and assessment of residents during and after the use of restraint.

Monitoring of the resident in and immediately after seclusion.

This provision mandates continuous monitoring of residents in seclusion and sets safety standards for seclusion rooms.

Notification of parent(s) or legal guardian(s).

This provision requires facilities to notify parents or legal guardians when a minor resident is restrained or placed in seclusion.

Application of time out.

This provision defines the requirements for the use and monitoring of time out as a behavioral intervention.

Postintervention debriefings.

This provision mandates face-to-face discussions and debriefing sessions following the use of restraint or seclusion.

Medical treatment for injuries resulting from an emergency safety intervention.

Facilities must ensure medical treatment for injuries from emergency safety interventions and maintain transfer agreements for necessary acute care.

Facility reporting.

Facilities must attest to compliance with restraint and seclusion standards and report serious occurrences, including deaths and injuries, to oversight agencies.

Education and training.

Facilities must provide ongoing staff training and competency demonstrations for emergency safety interventions, de-escalation, and cardiopulmonary resuscitation.

Behavioral health services.

Each resident must receive and the facility must provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive...

Basis and purpose.

This provision establishes the regulatory authority for intermediate care facility services for individuals with intellectual disabilities.

Relationship to other HHS regulations.

Facilities must comply with broader HHS regulations regarding nondiscrimination, human subjects research, and fraud and abuse.

Condition of participation: Governing body and management.

Facilities must maintain a governing body, comply with all applicable laws, manage client records, and ensure outside services meet quality standards.

Condition of participation: Client protections.

Facilities must protect client rights, manage finances, ensure privacy, and prohibit abuse, neglect, or mistreatment.

Condition of participation: Facility staffing.

This provision establishes requirements for facility staffing, including professional qualifications, direct care staff ratios, and staff training programs for facilities serving individuals with intellectual disabilities.

Condition of participation: Active treatment services.

This provision establishes the requirements for active treatment programs, including interdisciplinary team assessments, individual program plans, admission and discharge procedures, and program monitoring for facilities serving individuals with intellectual disabilities.

Pharmacy services.

This provision establishes requirements for the provision of pharmaceutical services, including drug regimen reviews, medication error prevention, and the safe storage and labeling of drugs in long-term care facilities.

Condition of participation: Client behavior and facility practices.

This provision mandates standards for managing client behavior, including the use of restraints, seclusion, and behavior-modifying drugs, while protecting client rights and safety.

Condition of participation: Health care services.

This provision establishes the requirements for physician, nursing, dental, pharmacy, and laboratory services in intermediate care facilities for individuals with intellectual disabilities.

Condition of participation: Physical environment.

This regulation establishes the physical environment, safety, fire protection, and infection control standards for Intermediate Care Facilities for Individuals with Intellectual Disabilities.

Condition of participation: Emergency preparedness.

This provision mandates that facilities establish and maintain a comprehensive emergency preparedness program, including risk assessments, communication plans, and training and testing protocols.

Condition of participation: Dietetic services.

This provision outlines the requirements for providing nourishing, well-balanced diets, including staffing, menu planning, and dining area standards.

Definitions.

As used in this subpart, the following definitions apply:

Laboratory, radiology, and other diagnostic services.

This provision establishes requirements for providing or obtaining diagnostic services, including quality standards, physician ordering, and clinical record documentation.

Dental services.

The facility must assist residents in obtaining routine and 24-hour emergency dental care.

Food and nutrition services.

The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident.

Specialized rehabilitative services.

This provision mandates that facilities provide or obtain specialized rehabilitative services, such as physical or respiratory therapy, as required by a patient's plan of care.

Administration.

A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.

Facility assessment.

The facility must conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations (including nights and weekends) and emergencies.

Emergency preparedness.

The LTC facility must comply with all applicable Federal, State and local emergency preparedness requirements.

Quality assurance and performance improvement.

Facilities must develop and maintain a comprehensive, data-driven quality assurance and performance improvement program that addresses clinical care, resident choice, and safety.

Infection control.

Facilities must establish an infection prevention and control program, including antibiotic stewardship, immunization policies, and mandatory reporting of respiratory illnesses.

Compliance and ethics program.

This provision mandates that facilities implement an effective compliance and ethics program to prevent and detect violations and promote quality of care.

Physical environment.

The facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public.

Training requirements.

Facilities must develop and maintain a comprehensive training program for staff, contractors, and volunteers covering topics such as abuse prevention, infection control, and compliance.