Medicare Nursing Home Requirements

According to the U.S. Centers for Medicare and Medicaid Services, nursing homes cannot receive payment through Medicare or Medicaid unless they are in compliance with specific federal requirements. Although state regulators license, evaluate and monitor nursing facilities, the federal requirements govern them. The requirements are extensive but they do fall into several main categories.

Residents

The U.S. Centers for Medicare and Medicaid Services (CMS) devotes several sections of the regulations to residents rights and behaviors. Nursing facilities must publish residents’ rights. Rights include the right to refuse treatment, the right to access his medical records and the right to be free of discrimination.

Services

Medicare regulations provide detailed requirements for services offered at a nursing facility.

Quality

CMS devotes multiple sections of the regulatory code to quality of life and quality care. According to the regulations, Medicare requires nursing facilities to provide the necessary care to allow residents the highest possible physical and mental well-being.

Staff

According to Medicare regulations for nursing homes, each type of paid staff in a nursing home–including doctors, nurses, nurses’ aides and feeding assistants–must meet minimum training and competency requirements and undergo regular evaluation.

Reporting

Medicare requirements for nursing facilities have extensive regulations for reporting to both state and federal agencies. Regular reports include staff training and continuing education, staff evaluations, adverse events that occur in the facility, annual quality reports and sworn statements of compliance with specific state and federal laws.