---
kind: "section"
citation: "42 U.S.C. § 1320a–7j"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1320a–7j"
heading: "Accountability requirements for facilities"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1320a-7j"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XI — General Provisions, Peer Review, and Administrative Simplification"
  - "Part A — General Provisions"
---

# §1320a–7j. Accountability requirements for facilities

- (a) **Definition of facility—** In this section, the term “[facility](/usc/42/1320a–3.md?p=c-5-B)” means—
  - (1) a skilled [nursing facility](/usc/42/1397j.md?p=17-A) (as defined in [section 1395i–3(a) of this title](/usc/42/1395i–3.md?p=a)); or
  - (2) a [nursing facility](/usc/42/1397j.md?p=17-A) (as defined in [section 1396r(a) of this title](/usc/42/1396r.md?p=a)).
- (b) **Effective compliance and ethics programs—**
  - (1) **Requirement—** On or after the date that is 36 months after March 23, 2010, a [facility](/usc/42/1320a–3.md?p=c-5-B) shall, with respect to the entity that operates the [facility](/usc/42/1320a–3.md?p=c-5-B) (in this subparagraph[^1] referred to as the “operating organization” or “organization”), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative [violations](/usc/42/2000e–16a.md?p=c) under this chapter and in promoting quality of care consistent with regulations developed under [paragraph (2)](#b-2).
  - (2) **Development of regulations—**
    - (A) **In general—** Not later than the date that is 2 years after March 23, 2010, the [Secretary](/usc/42/1301.md?p=a-6), working jointly with the Inspector General of the Department of Health and Human Services, shall promulgate regulations for an effective compliance and ethics program for operating organizations, which may include a model compliance program.
    - (B) **Design of regulations—** Such regulations with respect to specific elements or formality of a program shall, in the case of an organization that operates 5 or more [facilities](/usc/42/1320a–3.md?p=c-5-B), vary with the size of the organization, such that larger organizations should have a more formal program and include established written policies defining the [standards](/usc/42/1320d.md?p=7) and procedures to be followed by its employees. Such requirements may specifically apply to the corporate level management of multi unit nursing home chains.
    - (C) **Evaluation—** Not later than 3 years after the date of the promulgation of regulations under this paragraph, the [Secretary](/usc/42/1301.md?p=a-6) shall complete an evaluation of the compliance and ethics programs required to be established under this subsection. Such evaluation shall determine if such programs led to changes in deficiency citations, changes in quality performance, or changes in other metrics of patient quality of care. The [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
  - (3) **Requirements for compliance and ethics programs—** In this subsection, the term “compliance and ethics program” means, with respect to a [facility](/usc/42/1320a–3.md?p=c-5-B), a program of the operating organization that—
    - (A) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative [violations](/usc/42/2000e–16a.md?p=c) under this chapter and in promoting quality of care; and
    - (B) [includes](/usc/42/1301.md?p=b) at least the required components specified in [paragraph (4)](#b-4).
  - (4) **Required components of program—** The required components of a compliance and ethics program of an operating organization are the following:
    - (A) The organization must have established compliance [standards](/usc/42/1320d.md?p=7) and procedures to be followed by its employees and other agents that are reasonably capable of reducing the prospect of criminal, civil, and administrative [violations](/usc/42/2000e–16a.md?p=c) under this chapter.
    - (B) Specific individuals within high-level personnel of the organization must have been assigned overall responsibility to oversee compliance with such [standards](/usc/42/1320d.md?p=7) and procedures and have sufficient resources and authority to assure such compliance.
    - (C) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative [violations](/usc/42/2000e–16a.md?p=c) under this chapter.
    - (D) The organization must have taken steps to communicate effectively its [standards](/usc/42/1320d.md?p=7) and procedures to all employees and other agents, such as by requiring participation in training programs or by disseminating publications that explain in a practical manner what is required.
    - (E) The organization must have taken reasonable steps to achieve compliance with its [standards](/usc/42/1320d.md?p=7), such as by utilizing monitoring and auditing systems reasonably designed to detect criminal, civil, and administrative [violations](/usc/42/2000e–16a.md?p=c) under this chapter by its employees and other agents and by having in place and publicizing a reporting system whereby employees and other agents could report [violations](/usc/42/2000e–16a.md?p=c) by others within the organization without fear of retribution.
    - (F) The [standards](/usc/42/1320d.md?p=7) must have been consistently enforced through appropriate disciplinary mechanisms, [including](/usc/42/1301.md?p=b), as appropriate, discipline of individuals responsible for the failure to detect an offense.
    - (G) After an offense has been detected, the organization must have taken all reasonable steps to respond appropriately to the offense and to prevent further similar offenses, [including](/usc/42/1301.md?p=b) any necessary modification to its program to prevent and detect criminal, civil, and administrative [violations](/usc/42/2000e–16a.md?p=c) under this chapter.
    - (H) The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its [facilities](/usc/42/1320a–3.md?p=c-5-B).
- (c) **Quality assurance and performance improvement program—**
  - (1) **In general—** Not later than December 31, 2011, the [Secretary](/usc/42/1301.md?p=a-6) shall establish and implement a quality assurance and performance improvement program (in this subparagraph referred to as the “QAPI program”) for [facilities](/usc/42/1320a–3.md?p=c-5-B), [including](/usc/42/1301.md?p=b) multi unit chains of [facilities](/usc/42/1320a–3.md?p=c-5-B). Under the QAPI program, the [Secretary](/usc/42/1301.md?p=a-6) shall establish [standards](/usc/42/1320d.md?p=7) relating to quality assurance and performance improvement with respect to [facilities](/usc/42/1320a–3.md?p=c-5-B) and provide technical assistance to [facilities](/usc/42/1320a–3.md?p=c-5-B) on the development of best [practices](/usc/42/17061.md?p=19) in order to meet such [standards](/usc/42/1320d.md?p=7). Not later than 1 year after the date on which the regulations are promulgated under [paragraph (2)](#c-2), a [facility](/usc/42/1320a–3.md?p=c-5-B) must submit to the [Secretary](/usc/42/1301.md?p=a-6) a plan for the [facility](/usc/42/1320a–3.md?p=c-5-B) to meet such [standards](/usc/42/1320d.md?p=7) and implement such best [practices](/usc/42/17061.md?p=19), [including](/usc/42/1301.md?p=b) how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under sections [1395i–3(b)(1)(B)](/usc/42/1395i–3.md?p=b-1-B) and [1396r(b)(1)(B)](/usc/42/1396r.md?p=b-1-B) of this title, as applicable.
  - (2) **Regulations—** The [Secretary](/usc/42/1301.md?p=a-6) shall promulgate regulations to carry out this subsection.
- (f) **2 Standardized complaint form—**
  - (1) **Development by the Secretary—** The [Secretary](/usc/42/1301.md?p=a-6) shall develop a standardized complaint form for use by a resident (or a [person](/usc/42/1301.md?p=a-3) acting on the resident’s behalf) in filing a complaint with a [State](/usc/42/619.md?p=5) survey and certification [agency](/usc/42/1397n–12.md?p=1) and a [State long-term care ombudsman](/usc/42/1397j.md?p=22) program with respect to a [facility](/usc/42/1320a–3.md?p=c-5-B).
  - (2) **Complaint forms and resolution processes—**
    - (A) **Complaint forms—** The [State](/usc/42/619.md?p=5) must make the standardized complaint form developed under [paragraph (1)](#f-1) available upon request to—
      - (i) a resident of a [facility](/usc/42/1320a–3.md?p=c-5-B); and
      - (ii) any [person](/usc/42/1301.md?p=a-3) acting on the resident’s behalf.
    - (B) **Complaint resolution process—** The [State](/usc/42/619.md?p=5) must establish a complaint resolution process in order to ensure that the legal representative of a resident of a [facility](/usc/42/1320a–3.md?p=c-5-B) or other responsible party is not denied access to such resident or otherwise retaliated against if they have complained about the quality of care provided by the [facility](/usc/42/1320a–3.md?p=c-5-B) or other issues relating to the [facility](/usc/42/1320a–3.md?p=c-5-B). Such complaint resolution process shall include—
      - (i) procedures to assure accurate tracking of complaints received, [including](/usc/42/1301.md?p=b) notification to the complainant that a complaint has been received;
      - (ii) procedures to determine the likely severity of a complaint and for the investigation of the complaint; and
      - (iii) deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation.
  - (3) **Rule of construction—** Nothing in this subsection shall be construed as preventing a resident of a [facility](/usc/42/1320a–3.md?p=c-5-B) (or a [person](/usc/42/1301.md?p=a-3) acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under [paragraph (1)](#f-1) ([including](/usc/42/1301.md?p=b) submitting a complaint orally).
- (g) **Submission of staffing information based on payroll data in a uniform format—** Beginning not later than 2 years after March 23, 2010, and after consulting with [State long-term care ombudsman](/usc/42/1397j.md?p=22) programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the [Secretary](/usc/42/1301.md?p=a-6) deems appropriate, the [Secretary](/usc/42/1301.md?p=a-6) shall require a [facility](/usc/42/1320a–3.md?p=c-5-B) to electronically submit to the [Secretary](/usc/42/1301.md?p=a-6) [direct care](/usc/42/1397j.md?p=4) staffing information ([including](/usc/42/1301.md?p=b) information with respect to [agency](/usc/42/1397n–12.md?p=1) and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the [Secretary](/usc/42/1301.md?p=a-6) in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence—
  - (1) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);
  - (2) include resident census data and information on resident case mix;
  - (3) include a regular reporting schedule; and
  - (4) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in [paragraph (1)](#g-1) per resident per day.

  Nothing in this subsection shall be construed as preventing the [Secretary](/usc/42/1301.md?p=a-6) from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subsection with respect to [agency](/usc/42/1397n–12.md?p=1) and contract staff shall be kept separate from information on employee staffing.

- (h) **Notification of facility closure—**
  - (1) **In general—** Any individual who is the [administrator](/usc/42/4005.md?p=1) of a [facility](/usc/42/1320a–3.md?p=c-5-B) must—
    - (A) submit to the [Secretary](/usc/42/1301.md?p=a-6), the [State long-term care ombudsman](/usc/42/1397j.md?p=22), residents of the [facility](/usc/42/1320a–3.md?p=c-5-B), and the legal representatives of such residents or other responsible parties, written notification of an impending closure—
      - (i) subject to [clause (ii)](#h-1-A-ii), not later than the date that is 60 days prior to the date of such closure; and
      - (ii) in the case of a [facility](/usc/42/1320a–3.md?p=c-5-B) where the [Secretary](/usc/42/1301.md?p=a-6) terminates the [facility](/usc/42/1320a–3.md?p=c-5-B)’s participation under this subchapter, not later than the date that the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate;
    - (B) ensure that the [facility](/usc/42/1320a–3.md?p=c-5-B) does not admit any new residents on or after the date on which such written notification is submitted; and
    - (C) include in the notice a plan for the transfer and adequate relocation of the residents of the [facility](/usc/42/1320a–3.md?p=c-5-B) by a specified date prior to closure that has been approved by the [State](/usc/42/619.md?p=5), [including](/usc/42/1301.md?p=b) assurances that the residents will be transferred to the most appropriate [facility](/usc/42/1320a–3.md?p=c-5-B) or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident.
  - (2) **Relocation—**
    - (A) **In general—** The [State](/usc/42/619.md?p=5) shall ensure that, before a [facility](/usc/42/1320a–3.md?p=c-5-B) closes, all residents of the [facility](/usc/42/1320a–3.md?p=c-5-B) have been successfully relocated to another [facility](/usc/42/1320a–3.md?p=c-5-B) or an alternative home and community-based setting.
    - (B) **Continuation of payments until residents relocated—** The [Secretary](/usc/42/1301.md?p=a-6) may, as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, continue to make payments under this subchapter with respect to residents of a [facility](/usc/42/1320a–3.md?p=c-5-B) that has submitted a notification under [paragraph (1)](#h-1) during the period beginning on the date such notification is submitted and ending on the date on which the resident is successfully relocated.
  - (3) **Sanctions—** Any individual who is the [administrator](/usc/42/4005.md?p=1) of a [facility](/usc/42/1320a–3.md?p=c-5-B) that fails to comply with the requirements of [paragraph (1)](#h-1)—
    - (A) shall be subject to a civil monetary penalty of up to $100,000;
    - (B) may be subject to exclusion from participation in any Federal health care program (as defined in [section 1320a–7b(f) of this title](/usc/42/1320a–7b.md?p=f)); and
    - (C) shall be subject to any other penalties that may be prescribed by law.
  - (4) **Procedure—** The provisions of [section 1320a–7a of this title](/usc/42/1320a–7a.md) (other than subsections [(a)](#a) and [(b)](#b) and the second sentence of [subsection (f)](#f)) shall apply to a civil money penalty or exclusion under [paragraph (3)](#h-3) in the same manner as such provisions apply to a penalty or proceeding under [section 1320a–7a(a) of this title](/usc/42/1320a–7a.md?p=a).

## Footnotes

[^1]: So in original. Probably should be “subsection”.
[^2]: So in original. No subsecs. (d) and (e) have been enacted.

## Source credit

(Aug. 14, 1935, ch. 531, title XI, § 1128I, as added and amended Pub. L. 111–148, title VI, §§ 6102, 6105(a), 6106, 6113(a), Mar. 23, 2010, 124 Stat. 702, 711, 712, 718.)

## Notes

### Editorial Notes

### Amendments

2010—Subsec. (f). Pub. L. 111–148, § 6105(a), added subsec. (f).

Subsec. (g). Pub. L. 111–148, § 6106, added subsec. (g).

Subsec. (h). Pub. L. 111–148, § 6113(a), added subsec. (h).

### Statutory Notes and Related Subsidiaries

### Effective Date of 2010 Amendment

Pub. L. 111–148, title VI, § 6105(b), Mar. 23, 2010, 124 Stat. 712, provided that: “The amendment made by this section [amending this section] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”

Pub. L. 111–148, title VI, § 6113(c), Mar. 23, 2010, 124 Stat. 720, provided that: “The amendments made by this section [amending this section and section 1395i–3 of this title] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”

### National Independent Monitor Demonstration Project

Pub. L. 111–148, title VI, § 6112, Mar. 23, 2010, 124 Stat. 716, provided that:Establishment.— In general.—The Secretary [of Health and Human Services], in consultation with the Inspector General of the Department of Health and Human Services, shall conduct a demonstration project to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities. Selection.—The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the demonstration project under this section from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. Duration.—The Secretary shall conduct the demonstration project under this section for a 2-year period. Implementation.—The Secretary shall implement the demonstration project under this section not later than 1 year after the date of the enactment of this Act [Mar. 23, 2010]. Requirements.—The Secretary shall evaluate chains selected to participate in the demonstration project under this section based on criteria selected by the Secretary, including where evidence suggests that a number of the facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes a number of facilities participating in the ‘Special Focus Facility’ program (or a successor program) or multiple facilities with a record of repeated serious safety and quality of care deficiencies. Responsibilities.—An independent monitor that enters into a contract with the Secretary to participate in the conduct of the demonstration project under this section shall— conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with State and Federal laws and regulations applicable to the facilities; conduct sustained oversight of the efforts of the chain, whether publicly or privately held, to achieve compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities; analyze the management structure, distribution of expenditures, and nurse staffing levels of facilities of the chain in relation to resident census, staff turnover rates, and tenure; report findings and recommendations with respect to such reviews, analyses, and oversight to the chain and facilities of the chain, to the Secretary, and to relevant States; and publish the results of such reviews, analyses, and oversight.Implementation of Recommendations.— Receipt of finding by chain.—Not later than 10 days after receipt of a finding of an independent monitor under subsection (c)(4), a chain participating in the demonstration project shall submit to the independent monitor a report— outlining corrective actions the chain will take to implement the recommendations in such report; or indicating that the chain will not implement such recommendations, and why it will not do so. Receipt of report by independent monitor.—Not later than 10 days after receipt of a report submitted by a chain under paragraph (1), an independent monitor shall finalize its recommendations and submit a report to the chain and facilities of the chain, the Secretary, and the State or States, as appropriate, containing such final recommendations. Cost of Appointment.—A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the demonstration project under this section. The chain shall pay such portion to the Secretary (in an amount and in accordance with procedures established by the Secretary). Waiver Authority.—The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary for the purpose of carrying out the demonstration project under this section. Authorization of Appropriations.—There are authorized to be appropriated such sums as may be necessary to carry out this section. Definitions.—In this section: Additional disclosable party.—The term ‘additional disclosable party’ has the meaning given such term in section 1124(c)(5)(A) of the Social Security Act [42 U.S.C. 1320a–3(c)(5)(A)], as added by section 4201(a) [probably should be “6101(a)”]. Facility.—The term ‘facility’ means a skilled nursing facility or a nursing facility. Nursing facility.—The term ‘nursing facility’ has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)). Secretary.—The term ‘Secretary’ means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation. Skilled nursing facility.—The term ‘skilled nursing facility’ has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a) [1395i–3(a)]).Evaluation and Report.— Evaluation.—The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall evaluate the demonstration project conducted under this section. Report.—Not later than 180 days after the completion of the demonstration project under this section, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations— as to whether the independent monitor program should be established on a permanent basis; if the Secretary recommends that such program be so established, on appropriate procedures and mechanisms for such establishment; and for such legislation and administrative action as the Secretary determines appropriate.”