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7528.1 - When a Civil Money Penalty Subject to Being Collected and Placed inan Escrow Account is Imposed7528.2 - After Final Administrative Decision7528.3 - No Hearing Requested7528.4 - After Request to Waive Hearing7528.5 - After Substantial Compliance Is Achieved7528.6 - After Effective Date of Termination7530 - Notice of Amount Due and Collectible7530.1 - Contents of Notice7530.2 - Method of Payment7534 - Disposition of Collected Civil Money Penalty7534.1 - Collected From Medicare or Dually-Participating Facility7534.2 - Collected From Medicaid Facility7534.2.1 - Entities Other Than Nursing Homes May Receive CollectedCivil Money Penalty Funds From the State7534.3 - Collected From Dually Participating Facility7534.4 - Collected Amounts from a Dually-Participating Facility or MedicareFacility and Held in Escrow7535 – Uses of Civil Money Penalty Funds7536 - Loss of Nurse Aide Training and Competency Evaluation Program or CompetencyEvaluation Program as a Result of Civil Money Penalty7536.1 - Definition of “Assessed”7536.2 - Effective Date for Prohibition of Nurse Aide Training and CompetencyEvaluation Program or Competency Evaluation Program When Civil MoneyPenalty of 5,000 or More Is Assessed7550 - Temporary Management7550.1 - Introduction7550.2 - Purpose7550.3 - Authority of Temporary Manager7550.4 - Selection of Temporary Manager7550.5 - Conditions of Temporary Management7550.6 - Orienting and Supervising Temporary Manager7550.7 - Notice of Imposition of Temporary Management7550.8 - Duration7550.9 - Alternatives to Temporary Management7552 - Transfer of Residents and Transfer of Residents with Closure of Facility7552.1 - Introduction7552.2 - Responsibility for Transferring Residents7552.3 - State’s Prerogative to Close Facility and Transfer Residents

7556 - Termination Procedures for Skilled Nursing Facilities and Nursing FacilitiesWhen Facility Is Not in Substantial Compliance With Participation Requirements7556.1 - Introduction7556.2 - When There Is Immediate Jeopardy7556.3 - When There Is No Immediate Jeopardy7600 - Continuation of Payments During Correction7600.1 - Introduction7600.2 - Purpose7600.3 - Criteria for Continued Payment During Correction Period7600.4 - Approval of Plan and Timetable for Corrective Action7600.5 - Facility Takes Corrective Action According to Its Approved Plan ofCorrection and Has Achieved Substantial Compliance7600.6 - Facility Does Not Take Corrective Action According to Its ApprovedPlan of Correction and Has Not Achieved Substantial Compliance7600.7 - Facility Takes Corrective Action According to its Plan of Correction ButFails to Achieve Substantial Compliance7600.8 - Facility Does Not Take Corrective Action According to Its Plan ofCorrection and Has Achieved Substantial Compliance7600.9 - When State Opts for Alternative Remedies in Lieu of Termination andCriteria Are Not Met7700 - Nurse Aide Registry and Findings of Abuse, Neglect, or Misappropriation ofProperty7700.1- Notification Procedures- Preliminary Determinations7700.2 - Conduct of Hearing for Nurse Aides7700.3- Reporting Findings7701 - Reporting Abuse to Law Enforcement and the Medicaid Fraud Control UnitProgram Management7800 - Consistency of Survey Results7800.1 - Introduction7800.2 - Measuring Consistency7801 - Sanctions for Inadequate State Survey Performance7803 - Educational Programs7803.1 - Introduction7803.2 - Purpose7803.3 - Methodology7803.4 - Suggested Training Modalities7805 - Criteria for Reviewing State Plan Amendments for Specified and AlternativeEnforcement Remedies

7805.1 - Introduction7805.2 - Specified Remedies7805.3 - Alternative Remedies7805.4 - Additional Remedies7807 - State/Federal Disagreements About Timing and Choice of Remedies7807.1 - Introduction7807.2 - Disagreement About Whether Facility Has Met Requirements7807.3 - Disagreement About Decision to Terminate7807.4 - Disagreement About Timing of Facility Termination7807.5 - Disagreement About Remedies7807.6 - One Enforcement Decision7809 - Nurse Aide Training and Competency Evaluation Program and CompetencyEvaluation Program Disapprovals7809.1 - Introduction7809.2 - Applicability to Past Noncompliance7809.3 - Waiver of Program Disapproval7809.4 - Notice7809.5 - Change of Ownership7809.6 - Ability to Appeal a Finding of Substandard Quality of Care that Resultedin the Disapproval of a Nurse Aide Training and Competency Evaluation Program7809.7 – Effective Date of Disapproval of Nurse Aide Training and CompetencyEvaluation Program or Competency Evaluation ProgramDisclosure7900 - Information Disclosed to Public7901 - Requesting Public Information7902 - Charges for Information7903 - Time Periods for Disclosing Skilled Nursing Facility/Nursing Facility Information7903.1 - Information That Must Be Disclosed Within 14 Days of Request7903.2 - Disclosure Time frames7904 - Information Furnished to State’s Long Term Care Ombudsman7904.1 -Information Given to Long Term Care Ombudsman7904.2 - Federal Surveys7905 - Information Furnished to State by Facility with Substandard Quality of Care7905.1 - Information Provided to the State Survey Agency by Facility7905.2 - Failure to Provide Information Timely7905.3 - Federal Surveys7906 - Information Furnished to Attending Physician and State Board

7906.1 - State Notification of Noncompliance7906.2 - Federal Surveys7907 - Access to Information by State Medicaid Fraud Control Unit

7000 - Introduction(Rev. 63, Issued: 09-10-10, Effective: 09-10-10, Implementation: 09-10-10)Chapter 7 implements the nursing home survey, certification, and enforcementregulations at 42 CFR Part 488. No provisions contained in this chapter are intended tocreate any rights or remedies not otherwise provided in law or regulation.The nursing home reform regulation establishes several expectations. The first is thatproviders remain in substantial compliance with Medicare/Medicaid programrequirements as well as State law. The regulation emphasizes the need for continued,rather than cyclical compliance. The enforcement process mandates that policies andprocedures be established to remedy deficient practices and to ensure that correction islasting; specifically, that facilities take the initiative and responsibility for continuouslymonitoring their own performance to sustain compliance. Measures such as therequirements for an acceptable plan of correction emphasize the ability to achieve andmaintain compliance leading to improved quality of care. (See §7304.4 for plan ofcorrection requirements.)The second expectation is that all deficiencies will be addressed promptly. The standardfor program participation mandated by the regulation is substantial compliance. TheState and the regional office will take steps to bring about compliance quickly. Inaccordance with §7304, remedies such as civil money penalties, temporary managers,directed plans of correction, in-service training, denial of payment for new admissions,and State monitoring can be imposed before a facility has an opportunity to correct itsdeficiencies.The third expectation is that residents will receive the care and services they need to meettheir highest practicable level of functioning. The process detailed in these sectionsprovides incentives for the continued compliance needed to enable residents to reachthese goals.It should be noted that references to the State would be applicable, as appropriate, to theregional office throughout this chapter when the regional office is the surveying entity. Itshould also be noted that in cases where the State is authorized by CMS and/or the StateMedicaid Agency, the State may provide notice of imposition of certain remedies on theirbehalf, within applicable notice requirements.It should be noted that failure of CMS or the State to act timely does not invalidateotherwise legitimate survey and enforcement determinations.The ASPEN Enforcement Manager (AEM) is the data system used by CMS and all Statesfor data entry and reporting on nursing home survey and enforcement activities.

7001 - Definitions and Acronyms(Rev. 118, Issued: 06-12-14, Effective: 01-01-12, Implementation: 01-01-12)Abbreviated Standard Survey means a survey other than a standard survey that gathersinformation primarily through resident-centered techniques on facility compliance withthe requirements for participation. An abbreviated standard survey may be premised oncomplaints received; a change in ownership, management, or director of nursing; or otherindicators of specific concern. (42 CFR 488.301)Abuse - means the willful infliction of injury, unreasonable confinement, intimidation, orpunishment with resulting physical harm, pain, or mental anguish. (42 CFR 488.301)ACO - Automated Survey Processing Environment (ASPEN) Central Office.Act - the Social Security ActAEM - Automated Survey Processing Environment (ASPEN) Enforcement Manager.ASPEN - Automated Survey Processing Environment.CASPER - Certification and Survey Provider Enhanced Reporting.Certification of Compliance means that the facility is in at least substantial complianceand is eligible to participate in Medicaid as a nursing facility, or in Medicare as a skillednursing facility, or in both programs as a dually participating facility.Certification of Noncompliance means that the facility is not in substantial complianceand is not eligible to participate in Medicaid as a nursing facility, or in Medicare as askilled nursing facility, or in both programs as a dually participating facility.CFR - Code of Federal Regulations.CMP - civil money penalty.CMPTS - Civil Money Penalty Tracking System.CMS - Centers for Medicare & Medicaid Services (formerly HCFA).Deficiency means a skilled nursing facility’s or nursing facility’s failure to meet aparticipation requirement specified in the Act or in 42 CFR Part 483 Subpart B. (42 CFR488.301)DoPNA or DPNA - denial of payment for new admissions.DPoC - directed plan of correction.

Dually Participating Facility means a facility that has a provider agreement in both theMedicare and Medicaid programs.Educational programs means programs that include any subject pertaining to the longterm care participation requirements, the survey process, or the enforcement process.Enforcement action means the process of imposing one or more of the followingremedies: termination of a provider agreement; denial of participation; denial of paymentfor new admissions; denial of payment for all residents; temporary manager; civil moneypenalty; State monitoring; directed plan of correction; directed in-service training;transfer of residents; closure of the facility and transfer of residents; or other CMSapproved alternative State remedies.Expanded survey means an increase beyond the core tasks of a standard survey. Astandard survey may be expanded at the surveying entity’s discretion. When surveyorssuspect substandard quality of care they should expand the survey to determine ifsubstandard quality of care does exist.Extended survey means a survey that evaluates additional participation requirementssubsequent to finding substandard quality of care during a standard survey. (42 CFR488.301)Facility means a skilled nursing facility or nursing facility, or a distinct part of a skillednursing facility or nursing facility, in accordance with 42 CFR 483.5. (42 CFR 488.301)(See §7008 for entities that qualify as skilled nursing facilities and nursing facilities.)FSES – Fire Safety Evaluation System.IDR – informal dispute resolution.IJ – immediate jeopardy.Immediate family means a husband or wife; natural or adoptive parent, child or sibling;stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law,daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild. (42 CFR488.301.)Immediate jeopardy means a situation in which the facility’s noncompliance with oneor more requirements of participation has caused, or is likely to cause, serious injury,harm, impairment, or death to a resident. (42 CFR 488.301)Independent IDR – Independent informal dispute resolutionLSC – Life Safety Code.MAC means Medicare Area Contractor.

Misappropriation of resident property means the deliberate misplacement,exploitation, or wrongful, temporary or permanent use of a resident’s belongings ormoney without the resident’s consent. (42 CFR 488.301)NATCEP – Nurse Aide Training and Competency Evaluation Program.Neglect means failure to provide goods and services necessary to avoid physical harm,mental anguish, or mental illness. (42 CFR 488.301)New admission, for purposes of a denial of payment remedy, means a resident who isadmitted to the facility on or after the effective date of a denial of payment remedy and, ifpreviously admitted, has been discharged before that effective date. (See §7506 forexamples of what does and does not constitute a new admission for purposes of theremedy.) (42 CFR 488.401)NF – nursing facility.Noncompliance means any deficiency that causes a facility not to be in substantialcompliance. (42 CFR 488.301)No Opportunity to Correct means the facility will have remedies imposed immediatelyafter a determination of noncompliance has been made.NOTC – no opportunity to correct.Nurse aide means any individual providing nursing or nursing-related services toresidents in accordance with 42 CFR 483.75(e)(1). (CFR 42 488.301)Nursing facility means a Medicaid nursing facility. (42 CFR 488.301)OBRA ‘87 - the Omnibus Budget Reconciliation Act of 1987.Opportunity to Correct means the facility is allowed an opportunity to correct identifieddeficiencies before remedies are imposed.OTC – opportunity to correct.Partial extended survey means a survey that evaluates additional participationrequirements and verifies the existence of substandard quality of care during anabbreviated standard survey. (42 CFR 488.301.)Past Noncompliance means a deficiency citation at a specific survey data tag (F-tag orK-tag), that meets all of the following three criteria:1) The facility was not in compliance with the specific regulatory requirement(s) (asreferenced by the specific F-tag or K-tag) at the time the situation occurred;

2) The noncompliance occurred after the exit date of the last standard(recertification) survey and before the survey (standard, complaint, or revisit)currently being conducted, and3) There is sufficient evidence that the facility corrected the noncompliance and is insubstantial compliance at the time of the current survey for the specific regulatoryrequirement(s), as referenced by the specific F-tag or K-tag.Per day civil money penalty means a civil money penalty imposed for the number ofdays a facility is not in substantial compliance.Per instance civil money penalty means a civil money penalty imposed for eachinstance of facility noncompliance.PNC – past noncompliance.PoC - plan of correction. (42 CFR 488.401)QIES - Quality Improvement and Evaluation System.Representative-for purposes of educational programs, means family members, legalguardians, friends, and ombudsmen assigned to the facility; for purposes of IndependentIDR, means either the resident’s legal representative or the individual filing a complaintinvolving or on behalf of a resident.Self-Reported Noncompliance- Noncompliance that is reported by a facility to the StateSurvey Agency before it is identified by the State, CMS, or reported to the State or CMSby an entity other than the facility itself.SFF – Special Focus Facility.Skilled nursing facility means a Medicare-certified nursing facility that has a Medicareprovider agreement. (42 CFR 488.301)SMA – State Medicaid Agency.SNF – skilled nursing facility.SQC – substandard quality of care.Standard survey means a periodic, resident-centered inspection that gathers informationabout the quality of service furnished in a facility to determine compliance with therequirements of participation. (42 CFR 488.301)

State survey agency (SA) means the entity responsible for conducting most surveys tocertify compliance with the Centers for Medicare and Medicaid Services’ participationrequirements.State Medicaid Agency means the entity in the State responsible for administering theMedicaid program.Substandard quality of care means one or more deficiencies related to participationrequirements under 42 CFR 483.13, resident behavior and facilitypractices, 42 CFR 483.15, quality of life, or 42 CFR 483.25, quality of care, thatconstitute either immediate jeopardy to resident health or safety (level J, K, or L); apattern of or widespread actual harm that is not immediate jeopardy (level H or I); or awidespread potential for more than minimal harm, but less than immediate jeopardy, withno actual harm (level F). (42 CFR 488.301)Substantial compliance means a level of compliance with the requirements ofparticipation such that any identified deficiencies pose no greater risk to resident healthor safety than the potential for causing minimal harm. Substantial compliance constitutescompliance with participation requirements. (42 CFR 488.301)7002 - Change in Certification Status for Medicaid Nursing Facilities(Rev. 63, Issued: 09-10-10, Effective: 09-10-10, Implementation: 09-10-10)When Medicaid nursing facilities wish to participate as Medicare skilled nursingfacilities, the State does not necessarily need to conduct a new survey. The State submitsthe information obtained during the most recent Medicaid survey and otherdocumentation required for an initial certification of a skilled nursing facility to theregional office. The regional office will consider guidance in §2777D and §2778 of thismanual in making a determination about whether a new survey should be conducted.(Also see §1819(g) and §1919(g) of the Act, and 42 CFR 488.308 for authority toconduct surveys anytime there is a question about compliance.)7004 - Skilled Nursing Facility - Citations and Description(Rev. 63, Issued: 09-10-10, Effective: 09-10-10, Implementation: 09-10-10)7004.1 - Citations(Rev. 63, Issued: 09-10-10, Effective: 09-10-10, Implementation: 09-10-10)A skilled nursing facility is defined in §1819(a) of the Act and 42 CFR 488.301.7004.2 - Description of Skilled Nursing Facility(Rev. 63, Issued: 09-10-10, Effective: 09-10-

7010 - Skilled Nursing Facilities Providing Outpatient Physical Therapy, Speech Pathology, or Occupational Services 7012 - Reserved 7014 - Special Waivers Applicable to Skilled Nursing Facilities and Nursing Facilities 7014.1 - Waiver of Nurse Staffing Requirements 7014.1.1 - Waiver of 7-Day Registered Nurse (RN) Requirement for