State Operations Manual
The State Operations Manual (SOM for long-term care) contains the primary survey and certification rules and guidance from the Centers for Medicare and Medicaid Services Internet-Only Manual System for LTC providers. The entire manual can be accessed online here.
- The size and composition of the survey team, as well as survey frequency and timing, including determining the last day of survey and setting sanction time frames;
- The survey protocol for different survey types, including initial certifications, resurveys, abbreviated standard surveys, and state monitoring visits;
- The rules for substandard quality of care and extended and partial extended surveys;
- Informal dispute resolution and independent informal dispute resolution;
- Actions to be taken when a facility is not in substantial compliance, including when immediate jeopardy exists;
- Provider appeal of a certification of noncompliance;
- Acceptable plans of correction;
- State survey agency notice requirements in various scenarios;
- Enforcement actions and appropriate timing of those actions when immediate jeopardy exists or does not exist; and
- The rules for readmitting a SNF or dually participating facility to Medicare or Medicaid after termination.
- A listing of potential enforcement remedies and mandatory enforcement remedies;
- Factors surveyors should use when selecting remedies; and
- Life Safety Code enforcement guidelines.
- A directed plan of correction;
- Directed inservice training;
- State monitoring;
- Denial of payment for all New Medicare and Medicaid admissions; and
- Denial of payment for all Medicare and Medicaid residents.
- How the amount of a CMP should be determined;
- The duration of a CMP;
- When a CMP is due and payable;
- The rules for temporary management; and
- Termination procedures when a facility isn't in substantial compliance.
- Consistency of state survey results;
- State/federal disagreements about timing and choice of remedies; and
- Nurse aide training and competency evaluation program and competency evaluation program disapprovals.
- Time periods for disclosing SNF/NF information;
- Information that must be given to the long-term care ombudsman; and
- Information that must be furnished to the state by facilities with substandard quality of care.
Appendix PP, “Guidance to Surveyors for Long-term Care Facilities,” contains the relevant sections of the Code of Federal Regulations (42 CFR 483), the corresponding F-tags (F540 - F949), and the interpretive guidelines that surveyors are expected to use in assessing nursing facility compliance with the Medicare/Medicaid conditions of participation. The current Appendix PP is effective as of Oct. 24, 2022. These instructions cover the full range of operational, physical plant, and quality issues that surveyors assess.
Access the survey process entrance conference worksheet and provider matrix here. Access the survey tools, including Critical Element Pathways and Facility Task Pathways, here.