Medicare and Medicaid programs long-term care survey--HCFA. Final rule

This final rule responds to a Federal court order requiring that we publish regulations regarding a survey system that enables the Secretary to better assess whether high quality care is actually being furnished to Medicaid recipients in nursing homes. This rule represents a departure from, and an exception to, our position that the survey method used to determine compliance with program participation requirements can be modified without the need for change in our regulations. The final rule amends the Medicaid regulations to emphasize that the State survey agency must follow the survey methods and procedures prescribed by HCFA that are current at the time of the survey. This preamble describes the new resident-centered, outcome-oriented survey process that has been developed for use in nursing homes and follows through with the intent to implement such a process which we discussed in proposed rules published October 31, 1985 (50 FR 45584). We are also amending the Medicare regulations to conform to the Medicaid change and to make clear that the new process is also to be used in Medicare facilities. The new survey process, which has undergone extensive testing and refinement during the last few years, will provide a better basis than the current survey system for judging the quality of care actually provided to residents in skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) because it places greater emphasis on resident outcomes. This will enable surveyors to focus more directly on deficiencies that affect the health, safety and well-being of residents.