---
kind: "section"
citation: "42 C.F.R. § 440.155"
title: "42"
number: "440.155"
heading: "Nursing facility services, other than in institutions for mental diseases."
url: "https://uscodex.org/cfr/42/440.155"
---

# §440.155. Nursing facility services, other than in institutions for mental diseases.

- (a) “Nursing facility services, other than in an institution for mental diseases” means services provided in a facility that—
  - (1) Fully meets the requirements for a State license to provide, on a regular basis, health-related services to individuals who do not require hospital care, but whose mental or physical condition requires services that—
    - (i) Are above the level of room and board; and
    - (ii) Can be made available only through institutional facilities;
  - (2) Has been certified to meet the requirements of [subpart C of part 442](/cfr/42/part442-subpartC.md) of this chapter as evidenced by a valid agreement between the Medicaid agency and the facility for providing nursing facility services and making payments for services under the plan; and
- (b) “Nursing facility services” include services—
  - (1) Considered appropriate by the State and provided by a religious nonmedical institution as defined in [§ 440.170(b)](/cfr/42/440.170.md?p=b); or
  - (2) **Provided by a facility located on an Indian reservation that—**
    - (i) Furnishes, on a regular basis, health-related services; and
    - (ii) **Is certified by the Secretary to meet the standards in subpart E of part 442 of this chapter.**
- (c) “Nursing facility services” may include services provided in a distinct part (as defined in [§ 483.5(b)](/cfr/42/483.5.md?p=b) of this chapter) of a facility other than a nursing facility if the distinct part (as defined in [§ 483.5(b)](/cfr/42/483.5.md?p=b) of this chapter)—
  - (1) Meets all requirements for a nursing facility;
  - (2) Is an identifiable unit, such as an entire ward or contiguous ward, a wing, floor, or building;
  - (3) Consists of all beds and related facilities in the unit;
  - (4) Houses all beneficiaries for whom payment is being made for nursing facility services, except as provided in [paragraph (d)](#d) of this section;
  - (5) Is clearly identified; and
  - (6) **Is approved in writing by the survey agency.**
- (d) If a State includes as nursing facility services those services provided by a distinct part of a facility other than a nursing facility, it may not require transfer of a beneficiary within or between facilities if, in the opinion of the attending physician, it might be harmful to the physical or mental health of the beneficiary.
- (e) Nursing facility services may include services provided in a swing-bed hospital that has an approval to furnish nursing facility services.

## Notes

### Amendments

[59 FR 56234, Nov. 10, 1994, as amended at 64 FR 67052, Nov. 30, 1999; 68 FR 46071, Aug. 4, 2003]

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45224, Sept. 29, 1978, unless otherwise noted.

### Amendments

[59 FR 56234, Nov. 10, 1994, as amended at 64 FR 67052, Nov. 30, 1999; 68 FR 46071, Aug. 4, 2003]