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Federal and State Surveys

Federal Surveys

The Nursing Home Reform Act requires states to conduct unannounced surveys at least once every 15 months; which would include resident interviews. This type of monitoring falls under compliance with the federal standards of nursing homes.

The surveys, by definition,  are usually broad examinations of whether residents are being respected and well-treated . The interviews focus on quality of care and life, resident rights and provided services to the residents. If the surveys uncover violations, the government decides how to remedy the violation(s) based on their severity. These unannounced surveys and enforcement helps keep nursing homes accountable and enforces the Nursing Home Reform Act standards.

The following is a list of possible punitive or corrective sanctions approved by the Nursing Home Reform Act to those nursing homes in violation of federal law:

  • Civil monetary penalties and fines
  • Denial of Medicaid or Medicare funding
  • Directed plan of correction
  • Government directed staff training
  • Government takeover of nursing home
  • Increased monitoring by the state government
  • Rejection of licenses and other forms of certification

State Surveys

Nursing homes who participate in Medicaid and Medicare are required by federal law to abide by an annual survey and certification process by its state’s health department. Nursing Homes must be in considerable compliance with Medicare and Medicaid requirements, as well as state law requirements.

Latest survey results must be readily available for review according to nursing home regulations. The survey determines whether the quality of care, as intended by the law and regulations and as needed by the resident, is being implemented by the nursing home.

If a nursing home is established to be violating nursing home regulations, federal law enforcement options include fining the nursing home, denying payment for new admissions, revoking Medicaid and Medicare certifications, transferring nursing home residents, and imposing temporary management upon the nursing home.

The survey and certification process creates several expectations of nursing homes, including the following:

  • Nursing homes participating in Medicare and Medicaid programs must remain in substantial compliance with the Medicaid/Medicare care requirements
  • All deficiencies will be addressed promptly
  • Residents will receive the care and services they need to meet their highest practicable level of functioning

If the annual certification survey finds a nursing home is incomplete because it does not meet a requirement of the federal nursing home regulations, the deficiency is recorded in a Survey Report Form. Deficiencies alleged by staff, residents or family members must be confirmed through records, interviews and observations. If staff, resident or family allegations are not confirmed through records, interviews, or observations, the nursing home cannot be alleged as deficient. Once a survey team determines that deficiencies exist, it determines the seriousness of the violations. It looks at whether the deficiency status constitutes immediate jeopardy or actual harm, as well as whether the deficiency is isolated, constitutes a pattern or is widespread in the nursing home.

The Medicare website lists the most recent federal survey results, populations of the nursing homes surveyed and facts about nursing homes’ ownership. This can be a valuable guide when selecting or re-selecting a nursing home for a loved one.