Series volume 7 thru rev. Label Medicare, medicaid, state operations manual : provider certification Instantiates Medicare, medicaid, state operations manual : provider certification Publication Washington, D. Label Medicare, medicaid, state operations manual : provider certification Publication Washington, D. Library Locations Map Details. Indiana State Library Borrow it. Ohio St.
Library Links. Layout options: Carousel Grid List Card. Include data citation:. Copy to clipboard Close. Cite Data - Experimental. Data Citation of the Item Medicare, medicaid, state operations manual : provider certification. The entire manual can be accessed online here. It outlines CMS's role in the process, as well as the responsibilities of the state survey agencies. Chapter 2, " The Certification Process ," reviews the requirements for initial certifications, the rules for approval or denial, and procedures for reconsideration; issues involving change of ownership and voluntary terminations from Medicare; readmission criteria after involuntary terminations from Medicare or Medicaid; and timing requirements for resurveys.
Chapter 4, " Program Administration and Fiscal Management ," explains the core roles and responsibilities of the federal government and the state survey agencies throughout the survey-and-certification process.
For example, this chapter includes information about the training process for surveyors, as well as federal minimum qualification standards for surveyors. Other sections cover the deeming and waiver of nurse aide training and competency evaluation requirements, as well as curriculum requirements for those programs; nurse aide registries; and Resident Assessment Instrument specifications, including state-specified RAI requirements. Specific sections related to nursing homes include: investigation of complaints for nursing homes; action on complaints of resident neglect and abuse, and misappropriation of resident property; reporting findings of abuse, neglect, or misappropriation of property to the nurse aide registry; reporting abuse to law enforcement and the Medicaid fraud control unit; and post-survey certification actions for nursing homes.
Chapter 7, " Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities ," is the core "how to" chapter of the State Operations Manual for nursing home surveys and enforcement actions by state agencies. The chapter opens with definitions of a skilled nursing facility and a nursing facility, and explains special waivers that may apply to SNFs and NFs, such as a waiver of the seven-day RN Requirement for SNFs.
In addition, this chapter covers: The survey process. The enforcement process. Topics in these sections include but are not limited to: A listing of potential enforcement remedies and mandatory enforcement remedies; Factors surveyors should use when selecting remedies; and Life Safety Code enforcement guidelines. Topics in these sections include but are not limited to: 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.
Civil money penalties.
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