C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 483—REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES › Subpart B—Requirements for Long Term Care Facilities

42 C.F.R. § 483.30

Physician services

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A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician. A physician, physician assistant, nurse practitioner, or clinical nurse specialist must provide orders for the resident's immediate care and needs.

(a) Physician supervision. The facility must ensure that—

(1) The medical care of each resident is supervised by a physician; and

(2) Another physician supervises the medical care of residents when their attending physician is unavailable.

(b) Physician visits. The physician must—

(1) Review the resident's total program of care, including medications and treatments, at each visit required by paragraph (c) of this section;

(2) Write, sign, and date progress notes at each visit; and

(3) Sign and date all orders with the exception of influenza and pneumococcal vaccines, which may be administered per physician-approved facility policy after an assessment for contraindications.

(c) Frequency of physician visits. (1) The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.

(2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.

(3) Except as provided in paragraphs (c)(4) and (f) of this section, all required physician visits must be made by the physician personally.

(4) At the option of the physician, required visits in SNFs after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section.

(d) Availability of physicians for emergency care. The facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency.

(e) Physician delegation of tasks in SNFs. (1) Except as specified in paragraph (e)(4) of this section, a physician may delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who—

(i) Meets the applicable definition in § 491.2 of this chapter or, in the case of a clinical nurse specialist, is licensed as such by the State;

(ii) Is acting within the scope of practice as defined by State law; and

(iii) Is under the supervision of the physician.

(2) A resident's attending physician may delegate the task of writing dietary orders, consistent with § 483.60, to a qualified dietitian or other clinically qualified nutrition professional who—

(i) Is acting within the scope of practice as defined by State law; and

(ii) Is under the supervision of the physician.

(3) A resident's attending physician may delegate the task of writing therapy orders, consistent with § 483.65, to a qualified therapist who—

(i) Is acting within the scope of practice as defined by State law; and

(ii) Is under the supervision of the physician.

(4) A physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies.

(f) Performance of physician tasks in NFs. At the option of the State, any required physician task in a NF (including tasks which the regulations specify must be performed personally by the physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician.

[56 FR 48875, Sept. 26, 1991, as amended at 67 FR 61814, Oct. 2, 2002. Redesignated and amended at 81 FR 68861, Oct. 4, 2016]
Notes of Decisions
Cited in 21 cases (5 in the last 5 years), 2002–2024 · leading case: Jarman v. HCR ManorCare, Inc., 471 P.3d 1001 (Cal. 2020).
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Jarman v. HCR ManorCare, Inc., 471 P.3d 1001 (Cal. 2020). “Some specific rights were alleged in the pleadings, such as the right to sufficient staffing ( 42 C.F.R. § 483.30 ), the right to remain free from physical and mental abuse (Cal.”
Est. of Martha S. French v. Stratford House, 333 S.W.3d 546 (Tenn. 2011). “§§ 1395i — 3(b)(2), 1395Í3 (b)(3)(D); 1396r(b)(2); 1396r(b)(3)(D); 42 C.F.R. § 483.30 . . See 42 C.F.R. § 409.”
Mariner Health Care v. Est. of Edwards, 964 So. 2d 1138 (Miss. 2007). “42 C.F.R. § 483.30 ; Miss. Min. Stds. § 201.”
Thomas v. Cnty. of Chester, 312 F. Supp. 3d 448 (E.D. Pa. 2018). “services that would allow patients or residents, including Louis Thomas, to attain or maintain the highest practicable, physical, mental, and psychological well-being, as required by 42 C.F.R. § 483.30 and 42 U.S.C. § 1396r(b)(4)(c).”
United States Ex Rel. Swan v. Covenant Care, Inc., 279 F. Supp. 2d 1212 (E.D. Cal. 2002). “” 42 C.F.R. §§ 483.30 , 488.7600(2001). The majority of Swan’s allegations focus on Covenant Care’s alleged failure to provide adequate care to its patients and purported falsification of records in violation of these federal regulations.”
Schroeder v. Shawano Cnty., 870 F. Supp. 2d 622 (E.D. Wis. 2012). “20 (k)(3)(ii) which requires services to be provided or arranged by qualified persons in accordance with each resident’s plan of care, and failure to comply with F353 ( 42 CFR § 483.30 (a)) relating to the provision of sufficient nursing staff.”
Campbell Ex Rel. Robinson v. Cottage Grove Nursing Home, L.P., 350 F. Supp. 2d 735 (S.D. Miss. 2004). “For example, defendants refer to plaintiff's allegation that "[t]he administrator is responsible and required to hire and maintain sufficient staff to ensure that these residents' needs are met,” and direct the court's attention to 42 C.F.R. § 483.30 , which provides that "[t]he…”
United States of Am., ex rel. v. Cmty. Primary Care of Georgia, LLC (N.D. Ga. 2023). · cites it 8× “” 42 C.F.R. § 483.30 (c). In Counts I and II, Relator alleges Defendant submitted false claims because it failed to provide patients with the physician oversight required by 42 C.”
Golden Living Ctr. v. HHS (6th Cir. 2020). · cites it 6× “F353: Violation of 42 C.F.R. § 483.30 (a) In 2014, § 483.30(a) (“Nursing Services”) required a facility to “provide services by sufficient numbers of each of the following types of personnel on a 24–hour basis to provide nursing care to all residents in accordance with resident…”
Antoinette Windhurst v. Arizona Dep't of Corr. (Ariz. Ct. App. 2021). · cites it 2× “Rosner also cited the CMS standard of care for the availability of emergency services in 42 C.F.R. § 483.30 (d), which states that a “facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency.”
Armstrong v. Andover Subacute & Rehab Ctr. Servs. One, Inc. (D.N.J. 2019). · cites it 2× “40 was re-designated as 42 C.F.R. § 483.30 effective November 28, 2016.”
Schlaybach v. Berks Heim Nursing & Rehab. (E.D. Pa. 2020). · cites it 2× “aff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial wellbeing of each resident, as determined by resident assessments and individual plans of care, and here the Defendants failed to do so by failing to…”
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