How are Nursing Homes Regulated?

People who do not work in nursing homes may not be aware of how they are regulated and monitored. In most states, nursing homes are regulated by a combination of state (Department of Health) and Federal authorities (U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS).

CMS sets the Federal nursing home regulations. These are the “Requirements of Participation for Long-Term Care Facilities” for nursing homes who accept Medicare or Medicaid, or both. The regulations are the minimum standards to uphold.

Nursing homes undergo surveys to determine that they are in compliance with the Federal requirements. Skilled nursing facilities (SNFs) and nursing facilities (NFs) are required to be in compliance in order to be certified and receive payment under Medicare or Medicaid programs. There are protocols that are used for the surveys and interpretive guidelines that clarify and/or explain the intent of the regulations.

In Georgia, Healthcare Facility Regulation (HFR) regulates the quality of nursing home care, which is a division of the Georgia Department of Community Health (DCH). HFR is the state survey agency that performs Federal certification inspections.