42 C.F.R. §§ 403.730–403.746

§403.730. Condition of participation: Patient rights.

42 C.F.R. § 403.730

An RNHCI must protect and promote each patient's rights.

(a)

Standard: Notice of rights. The RNHCI must do the following:

(1)

Inform each patient of his or her rights in advance of furnishing patient care.

(2)

Have a process for prompt resolution of grievances, including a specific person within the facility whom a patient may contact to file a grievance. In addition, the facility must provide patients with information about the facility's process as well as with contact information for appropriate State and Federal resources.

(b)

Standard: Exercise of rights. The patient has the right to:

(1)

Be informed of his or her rights and to participate in the development and implementation of his or her plan of care.

(2)

Make decisions regarding his or her care, including transfer and discharge from the RNHCI. (See § 403.736 for discharge and transfer requirements.)

(3)

Formulate advance directives and expect staff who furnish care in the RNHCI to comply with those directives, in accordance with part 489, subpart I of this chapter. For purposes of conforming with the requirement in § 489.102 that there be documentation in the patient's medical records concerning advanced directives, the patient care records of a beneficiary in an RNHCI are equivalent to medical records held by other providers.

(c)

Standard: Privacy and safety. The patient has the right to the following:

(1)

Personal privacy.

(2)

Care in a safe setting.

(3)

Freedom from verbal, psychological, and physical abuse, and misappropriation of property.

(4)

Freedom from the use of restraints.

(5)

Freedom from involuntary seclusion.

(d)

Standard: Confidentiality of patient records. For any patient care records or election information it maintains on patients, the RNHCI must establish procedures to do the following:

(1)

Safeguard the privacy of any information that identifies a particular patient. Information from, or copies of, records may be released only to authorized individuals, and the RNHCI must ensure that unauthorized individuals cannot gain access to or alter patient records. Original patient care records must be released only in accordance with Federal or State laws, court orders, or subpoenas.

(2)

Maintain the records and information in an accurate and timely manner.

(3)

Ensure timely access by patients to the records and other information that pertains to that patient.

(4)

Abide by all Federal and State laws regarding confidentiality and disclosure for patient care records and election information.

Notes, amendments, and revision history

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

§403.732. Condition of participation: Quality assessment and performance improvement.

42 C.F.R. § 403.732

The RNHCI must develop, implement, and maintain a quality assessment and performance improvement program.

(a)

Standard: Program scope.

(1)

The quality assessment and performance improvement program must include, but is not limited to, measures to evaluate:

(i)

Access to care.

(ii)

Patient satisfaction.

(iii)

Staff performance.

(iv)

Complaints and grievances.

(v)

Discharge planning activities.

(vi)

Safety issues, including physical environment.

(2)

In each of the areas listed in paragraph (a)(1) of this section, and any other areas the RNHCI includes, the RNHCI must do the following:

(i)

Define quality assessment and performance improvement measures.

(ii)

Describe and outline quality assessment and performance improvement activities appropriate for the services furnished by or in the RNHCI.

(iii)

Measure, analyze, and track performance that reflect care and RNHCI processes.

(iv)

Inform all patients, in writing, of the scope and responsibilities of the quality assessment and performance improvement program.

(3)

The RNHCI must set priorities for performance improvement, considering the prevalence of and severity of identified problems.

(4)

The RNHCI must act to make performance improvements and must track performance to assure that improvements are sustained.

(b)

Standard: Program responsibilities.

(1)

The governing body, administration, and staff are responsible for ensuring that the quality assessment and performance improvement program addresses identified priorities in the RNHCI and are responsible for the development, implementation, maintenance, and performance improvement of assessment actions.

(2)

The RNHCI must include all programs, departments, functions, and contracted services when developing, implementing, maintaining, and evaluating the program of quality assessment and performance improvement.

Notes, amendments, and revision history

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

§403.734. Condition of participation: Food services.

42 C.F.R. § 403.734

The RNHCI must have an organized food service that is directed and adequately staffed by qualified personnel.

(a)

Standard: Sanitary conditions. The RNHCI must furnish food to the patient that is obtained, stored, prepared, distributed, and served under sanitary conditions.

(b)

Standard: Meals. The RNHCI must serve meals that furnish each patient with adequate nourishment in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences. The RNHCI must do the following:

(1)

Furnish food that is palatable, attractive, and at the proper temperature and consistency.

(2)

Offer substitutes of similar nourishment to patients who refuse food served or desire alternative choices.

(3)

Furnish meals at regular times comparable to normal mealtimes in the community. There must be no more than 14 hours between a substantial evening meal and breakfast the following day.

(4)

The RNHCI must offer snacks at bedtime.

Notes, amendments, and revision history

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

§403.736. Condition of participation: Discharge planning.

42 C.F.R. § 403.736

(a)

Discharge planning and instructions. The RNHCI must have in effect a discharge planning process that applies to all patients. The process must assure that appropriate post-institution services are obtained for each patient, as necessary. The RNHCI must assess the need for a discharge plan for any patient likely to suffer adverse consequences if there is no planning.

(1)

Discharge instructions must be provided at the time of discharge to the patient or the patient's caregiver as necessary.

(2)

If the patient assessment indicates a need for a discharge plan, the discharge plan must include instructions on post-RNHCI care to be used by the patient or the caregiver in the patient's home, as identified in the discharge plan.

(3)

If the RNHCI's patient assessment does not indicate a need for a discharge plan, the beneficiary or his or her legal representative may request a discharge plan. In this case, the RNHCI must develop a discharge plan for the beneficiary.

(b)

Standard: Transfer or referral. The RNHCI must transfer or refer patients in a timely manner to another facility (including a medical facility if requested by the beneficiary, or his or her legal representative) in accordance with § 403.730(b)(2).

(c)

Standard: Reassessment. The RNHCI must reassess its discharge planning process on an ongoing basis. The reassessment must include a review of discharge plans to ensure that they are responsive to discharge needs.

Notes, amendments, and revision history

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 68 FR 66720, Nov. 28, 2003; 84 FR 51813, Sept. 30, 2019]

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 68 FR 66720, Nov. 28, 2003; 84 FR 51813, Sept. 30, 2019]

§403.738. Condition of participation: Administration.

42 C.F.R. § 403.738

An RNHCI must have written policies regarding its organization, services, and administration.

(a)

Standard: Compliance with Federal, State, and local laws. The RNHCI must operate in compliance with all applicable Federal, State, and local laws, regulations, and codes including, but not limited to, those pertaining to the following:

(1)

Protection against discrimination on the basis of race, color, national origin, age, or handicap (45 CFR parts 80, 84, and 91).

(2)

Protection of human research subjects (45 CFR part 46).

(3)

Application of all safeguards to protect against the possibility of fraud and abuse (42 CFR part 455).

(4)

Privacy of individually identifiable health information (45 CFR part 164).

(b)

Standard: Governing body.

(1)

The RNHCI must have a governing body, or a person designated to function as a governing body, that is legally responsible for establishing and implementing all policies regarding the RNHCI's management and operation.

(2)

The governing body must appoint the administrator responsible for the management of the RNHCI.

(c)

Standard: Affiliations and disclosure.

(1)

An affiliation is permissible if it is between one of the following—

(i)

An individual serving as an uncompensated director, trustee, officer, or other member of the governing body of an RNHCI and a provider of medical treatment or services.

(ii)

An individual who is a director, trustee, officer, employee, or staff member of an RNHCI and another individual, with whom he or she has a family relationship, who is affiliated with (or has an ownership interest in) a provider of medical treatment or services.

(iii)

The RNHCI and an individual or entity furnishing goods or services as a vendor to both providers of medical treatment or services and RNHCIs.

(2)

The RNHCI complies with the disclosure requirements of §§ 420.206 and 455.104 of this chapter.

(3)

The RNHCI furnishes written notice, including the identity of each new individual or company, to CMS at the time of a change, if a change occurs in any of the following:

(i)

Persons with an ownership or control interest, as defined in §§ 420.201 and 455.101 of this chapter.

(ii)

The officers, directors, agents, or managing employees.

(iii)

The religious entity, corporation, association, or other company responsible for the management of the RNHCI.

(iv)

The RNHCI's administrator or director of nonmedical nursing services.

Notes, amendments, and revision history

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 68 FR 66720, Nov. 28, 2003]

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 68 FR 66720, Nov. 28, 2003]

§403.740. Condition of participation: Staffing.

42 C.F.R. § 403.740

The RNHCI must be staffed with qualified experienced personnel who are present in sufficient numbers to meet the needs of the patients.

(a)

Standard: Personnel qualifications. The RNHCI must ensure that staff who supervise or furnish services to patients are qualified to do so and that staff allowed to practice without direct supervision have specific training to furnish these services.

(b)

Standard: Education, training, and performance evaluation.

(1)

The RNHCI must ensure that staff (including contractors and other individuals working under arrangement) have the necessary education and training concerning their duties so that they can furnish services competently. This education includes, but is not limited to, training related to the individual job description, performance expectations, applicable organizational policies and procedures, and safety responsibilities.

(2)

Staff must demonstrate, in practice, the skills and techniques necessary to perform their duties and responsibilities.

(3)

The RNHCI must evaluate the performance of staff and implement measures for improvement.

Notes, amendments, and revision history

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

§403.742. Condition of participation: Physical environment.

42 C.F.R. § 403.742

A RNHCI must be designed, constructed, and maintained to ensure the safety of the patients, staff, and the public.

(a)

Standard: Buildings. The physical plant and the overall environment must be maintained in a manner that ensures the safety and well-being of the patients. The RNHCI must have the following:

(1)

Procedures for the proper storage and disposal of trash.

(2)

Proper ventilation and temperature control and appropriate lighting levels to ensure a safe and secure environment.

(3)

An effective pest control program.

(4)

A preventive maintenance program to maintain essential mechanical, electrical, and fire protection equipment operating in an efficient and safe manner.

(5)

A working call system for patients to summon aid or assistance.

(b)

Standard: Patient rooms. Patient rooms must be designed and equipped for adequate care, comfort, and privacy of the patient.

(1)

Patient rooms must meet the following conditions:

(i)

Accommodate no more than four patients.

(ii)

Measure at least 80 square feet per patient in multiple patient rooms and at least 100 square feet in single patient rooms.

(iii)

Have direct access to an exit corridor.

(iv)

Be designed or equipped to assure full visual privacy for each patient.

(v)

Have at least one window to the outside.

(vi)

Have a floor at or above grade level.

(2)

The RNHCI must furnish each patient with the following:

(i)

A separate bed of proper size and height for the convenience of the patient.

(ii)

A clean, comfortable mattress.

(iii)

Bedding appropriate to the weather and climate.

(iv)

Functional furniture appropriate to the patient's needs and individual closet space with clothes racks and shelves accessible to the patient.

(3)

CMS may permit variances in requirements specified in paragraphs (b)(1)(i) and (ii) of this section relating to rooms on an individual basis when the RNHCI adequately demonstrates in writing that the variances meet the following:

(i)

Are in accordance with the special needs of the patients.

(ii)

Will not adversely affect patients' health and safety.

Notes, amendments, and revision history

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 81 FR 64021, Sept. 16, 2016]

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 81 FR 64021, Sept. 16, 2016]

§403.744. Condition of participation: Life safety from fire.

42 C.F.R. § 403.744

(a)

General. An RNHCI must meet the following conditions:

(1)

Except as otherwise provided in this section—

(i)

The RNHCI must meet the applicable provisions and must proceed in accordance with the Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4).

(ii)

Notwithstanding paragraph (a)(1)(i) of this section, corridor doors and doors to rooms containing flammable or combustible materials must be provided with positive latching hardware. Roller latches are prohibited on such doors.

(2)

The RNHCI must have written fire control plans that contain provisions for prompt reporting of fires; extinguishing fires; protection of patients, staff, and the public; evacuation; and cooperation with fire fighting authorities.

(3)

The RNHCI must maintain written evidence of regular inspection and approval by State or local fire control agencies.

(4)

The RNHCI may place alcohol-based hand rub dispensers in its facility if the dispensers are installed in a manner that adequately protects against inappropriate access.

(5)

When a sprinkler system is shut down for more than 10 hours the RHNCI must—

(i)

Evacuate the building or portion of the building affected by the system outage until the system is back in service, or

(ii)

Establish a fire watch until the system is back in service.

(6)

Building must have an outside window or outside door in every sleeping room, and for any building constructed after July 5, 2016 the sill height must not exceed 36 inches above the floor. Windows in atrium walls are considered outside windows for the purposes of this requirement.

(b)

Exceptions.

(1)

In consideration of a recommendation by the State survey agency or Accrediting Organization, or at the discretion of the Secretary, may waive, for periods deemed appropriate, specific provisions of the Life Safety Code, which would result in unreasonable hardship upon a RNHCI facility, but only if the waiver will not adversely affect the health and safety of the patients.

(2)

If CMS finds that the fire and safety code imposed by State law adequately protects patients in the institution, the provisions of the Life Safety Code required in paragraph (a)(1) of this section do not apply in that State.

(c)

The standards incorporated by reference in this section are approved for incorporation by reference by the Director of the Office of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. You may inspect a copy at the CMS Information Resource Center, 7500 Security Boulevard, Baltimore, MD or at the National Archives and Records Administration (NARA). For information on the availability of this material at NARA, call 202-741-6030, or go to: http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html. If any changes in this edition of the Code are incorporated by reference, CMS will publish a document in the Federal Register to announce the changes.

(1)

National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169, www.nfpa.org, 1.617.770.3000.

(i)

NFPA 101, Life Safety Code, 2012 edition, issued August 11, 2011;

(ii)

TIA 12-1 to NFPA 101, issued August 11, 2011.

(iii)

TIA 12-2 to NFPA 101, issued October 30, 2012.

(iv)

TIA 12-3 to NFPA 101, issued October 22, 2013.

(v)

TIA 12-4 to NFPA 101, issued October 22, 2013.

(2)

[Reserved]

Notes, amendments, and revision history

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 68 FR 1385, Jan. 10, 2003; 69 FR 18803, Apr. 9, 2004; 69 FR 49240, Aug. 11, 2004; 70 FR 15237, Mar. 25, 2005; 70 FR 71007, Nov. 25, 2005; 71 FR 55339, Sept. 22, 2006; 81 FR 26896, May 4, 2016]

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 68 FR 1385, Jan. 10, 2003; 69 FR 18803, Apr. 9, 2004; 69 FR 49240, Aug. 11, 2004; 70 FR 15237, Mar. 25, 2005; 70 FR 71007, Nov. 25, 2005; 71 FR 55339, Sept. 22, 2006; 81 FR 26896, May 4, 2016]

§403.745. Condition of participation: Building safety.

42 C.F.R. § 403.745

(a)

Standard: Building Safety. Except as otherwise provided in this section the RNHCI must meet the applicable provisions and must proceed in accordance with the Health Care Facilities Code (NFPA 99 and Tentative Interim Amendments TIA 12-2, TIA 12-3, TIA 12-4, TIA 12-5 and TIA 12-6).

(b) Standard: Exceptions. Chapters 7, 8, 12, and 13 of the adopted Health Care Facilities Code do not apply to a RNHCI.

(c)

Waiver. If application of the Health Care Facilities Code required under paragraph (a) of this section would result in unreasonable hardship for the RNHCI, CMS may waive specific provisions of the Health Care Facilities Code, but only if the waiver does not adversely affect the health and safety of individuals.

(d)

Incorporation by reference. The standards incorporated by reference in this section are approved for incorporation by reference by the Director of the Office of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. You may inspect a copy at the CMS Information Resource Center, 7500 Security Boulevard, Baltimore, MD or at the National Archives and Records Administration (NARA). For information on the availability of this material at NARA, call 202-741-6030, or go to: http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html. If any changes in this edition of the Code are incorporated by reference, CMS will publish a document in the Federal Register to announce the changes.

(1)

National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169, www.nfpa.org, 1.617.770.3000.

(i)

NFPA 99, Standards for Health Care Facilities Code of the National Fire Protection Association 99, 2012 edition, issued August 11, 2011.

(ii)

TIA 12-2 to NFPA 99, issued August 11, 2011.

(iii)

TIA 12-3 to NFPA 99, issued August 9, 2012.

(iv)

TIA 12-4 to NFPA 99, issued March 7, 2013.

(v)

TIA 12-5 to NFPA 99, issued August 1, 2013.

(vi)

TIA 12-6 to NFPA 99, issued March 3, 2014.

(2)

[Reserved]

Notes, amendments, and revision history

Amendments

[81 FR 26896, May 4, 2016]

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Amendments

[81 FR 26896, May 4, 2016]

§403.746. Condition of participation: Utilization review.

42 C.F.R. § 403.746

The RNHCI must have in effect a written utilization review plan to assess the necessity of services furnished. The plan must provide that records be maintained of all meetings, decisions, and actions by the utilization review committee.

(a)

Standard: Utilization review plan. The utilization review plan must contain written procedures for evaluating the following:

(1)

Admissions.

(2)

Duration of care.

(3)

Continuing care of an extended duration.

(4)

Items and services furnished.

(b)

Standard: Utilization review committee. The committee is responsible for evaluating each admission and ensuring that the admission is necessary and appropriate. The utilization review plan must be carried out by the utilization review committee, consisting of the governing body, administrator or other individual responsible for the overall administration of the RNHCI, the supervisor of nursing staff, and other staff as appropriate.

(c)

Standard: Utilization review committee role in RNHCI home services. In addition to the requirements in paragraphs (a) and (b) of this section, the utilization review committee is responsible for:

(1)

The admission, and at least every 30 days, the continued care review of each patient in the RHNCI home services program.

(2)

Oversight and monitoring of the home services program, including the purchase and utilization of designated durable medical equipment items for beneficiaries in the program.

Notes, amendments, and revision history

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 69 FR 66419, Nov. 15, 2004]

Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Amendments

[64 FR 67047, Nov. 30, 1999, as amended at 69 FR 66419, Nov. 15, 2004]