Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services
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Licensing and Certification

Survey and Certification

Each state has a survey and certification agency that works to ensure that healthcare delivered by providers is safe, cost effective, and compliant with all state and federal laws. Nursing homes must be licensed to operate according to their state’s licensure requirements. 

The Centers for Medicare and Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency which administers Medicare, Medicaid, and the Children’s Health Insurance Program. CMS is also the agency responsible for enforcing quality standards in nursing homes through its survey and certification process. Those nursing homes wishing to receive reimbursement from Medicare and/or Medicaid must also be certified by the state that they are in compliance with the requirements of the Nursing Home Reform Act regulations (found at 42 CFR Part 483, Subpart B).

Information from CMS - Nursing Home Survey and Enforcement Process

State Operations Manual (SOM)
CMS's State Operations Manual (SOM) provides guidance to surveyors of long-term care facilities on interpreting the requirements. Visit the CMS website to find the most recent link to the State Operations Manual (SOM).

CMS Surveyor Training 
Online training by CMS for surveyors, includes webcasts, web-based training, and modules on Reduction in Unnecessary Medications in Nursing Homes. 

CMS Policy and Memos to States and Regions
This webpage has links to CMS Quality Safety & Oversight memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.

CMS Skilled Nursing Facility Center
This webpage has links to information about skilled nursing facilities, including CMS manuals and transmittals, policies and regulations, and educational resources.

Information to Share with Consumers

Nursing Home Compare
Nursing Home Compare allows consumers to compare information about nursing homes. It contains quality of care information on every Medicare and Medicaid-certified nursing home in the country, including over 15,000 nationwide.  Note: Nursing homes aren't included on Nursing Home Compare if they aren't certified to participate in Medicare or Medicaid. These Nursing Homes can be licensed by the state.

  • Five-Star Quality Rating System
    CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.



View archive here

The Interpretive Guidelines: A Tool for Advocacy (September 2012)
The guidance to surveyors, Appendix PP - Guidance to Surveyors of Long-Term Care Facilities, often called the Interpretive Guidelines, can be an important tool for advocates promoting quality in long-term care facilities.  This resource details how you can use the Interpretive Guidelines in your advocacy efforts.

Evaluation of the Quality Indicator Survey (QIS) (December 2007)

Supporting the Ombudsman's New Role in the Long-Term Care Survey Process (October 1991)
Surveyors are instructed to seek information from ombudsmen about their experiences at the nursing home and to invite ombudsmen to the survey exit conference. This technical assistance brief details the extent of the ombudsman role in the survey process.


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