Quality Safety & Oversight - Guidance to Laws & Regulations

The Medicare Conditions of Participation, Conditions for Coverage and Requirements for Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs) are sets of requirements for acceptable quality in the operation of health care entities.  There is a set of Conditions (or Requirements for SNFs and NFs) for each type of provider or supplier subject to certification.  In addition to each Condition (or Requirement for SNFs and NFs) there is a group of related quality standards, with the Condition or Requirement expressed in a summary lead sentence or paragraph characterizing the quality or result of operations to which all the subsidiary standards are directed.  The State Survey Agency ascertains, by a survey conducted by qualified health professionals, whether and how each standard is met. 

The Interpretive Guidelines serve to interpret and clarify the Conditions (or Requirements for SNFs and NFs). The Interpretive Guidelines merely define or explain the relevant statute and regulations and do not impose any requirements that are not otherwise set forth in statute or regulation.

Each provider type is surveyed in accordance with the appropriate protocols based on the substantive requirements in the statute and regulations to determine whether a citation of non-compliance is appropriate.  Deficiencies are based on a violation of the statute or regulations, which, in turn, are based on observations of the providers' performance or practices. 

While an institution may fail to comply with one or more of the subsidiary standards during any given survey, it cannot participate in Medicare unless it meets each and every Condition or attains substantial compliance with requirements for SNFs and NFs.

Under Related Links Inside CMS, we refer you to our "Manuals" page where you will find a table of contents and current files for all of the State Operations Appendices (with a few exceptions - see note below).