42 C.F.R. § 488.26

Determining compliance

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(a) Additional rules for certification of compliance for SNFs and NFs are set forth in § 488.330.

(b) The decision as to whether there is compliance with a particular requirement, condition of participation, or condition for coverage depends upon the manner and degree to which the provider or supplier satisfies the various standards within each condition. Evaluation of a provider's or supplier's performance against these standards enables the State survey agency to document the nature and extent of deficiencies, if any, with respect to a particular function, and to assess the need for improvement in relation to the prescribed conditions.

(c) The State survey agency must adhere to the following principles in determining compliance with participation requirements:

(1) The survey process is the means to assess compliance with Federal health, safety and quality standards;

(2) The survey process uses resident and patient outcomes as the primary means to establish the compliance process of facilities and agencies. Specifically, surveyors will directly observe the actual provision of care and services to residents and/or patients, and the effects of that care, to assess whether the care provided meets the needs of individual residents and/or patients.

(3) Surveyors are professionals who use their judgment, in concert with Federal forms and procedures, to determine compliance;

(4) Federal procedures are used by all surveyors to ensure uniform and consistent application and interpretation of Federal requirements;

(5) Federal forms are used by all surveyors to ensure proper recording of findings and to document the basis for the findings.

(d) The State survey agency must use the survey methods, procedures, and forms that are prescribed by CMS.

(e) The State survey agency must ensure that a facility's or agency's actual provision of care and services to residents and patients and the effects of that care on such residents and patients are assessed in a systematic manner.

[59 FR 56237, Nov. 10, 1994, as amended at 77 FR 67164, Nov. 8, 2012]

Notes of Decisions

Cited in 6 cases (3 in the last 5 years), 1994–2025 · leading case: Evelyn v. v. Kings Cnty. Hosp. Ctr., 956 F. Supp. 288 (E.D.N.Y 1997).

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Evelyn v. v. Kings Cnty. Hosp. Ctr., 956 F. Supp. 288 (E.D.N.Y 1997). · cites it 2× “42 C.F.R. § 488.26 (c)(1) describes the survey process as “the means to assess compliance with Federal health, safety and quality standards.”

Woodruff v. Wilson, 484 F. Supp. 2d 876 (S.D. Ind. 2007). “42 CFR § 488.26 (c)(3). More specifically, for nursing facilities that receive Medicare or Medicaid reimbursement, ISDH must certify that the facility complies “with the conditions of participation, requirements (for [skilled nursing facilities,] SNFs and [nursing facilities,]…”

In Re Assessment Issued to Leisure Hills Health Care Ctr. on March 2, 1992, 518 N.W.2d 71 (Minn. Ct. App. 1994). “42 C.F.R. § 488.26 . In addition to these general requirements, the federal government has issued specific survey procedures that states should follow to determine whether a facility complies with federal requirements.”

Tower Health v. Chs/Cmty. Health Sys., Inc. (E.D. Pa. 2022). · cites it 2× “See 42 C.F.R. § 488.26 (setting forth rules relating to determining compliance).”

Connor v. Maryland Dep't of Health (D. Maryland 2025). · cites it 2× “§ 1396r(g)(1)(A), (g)(1)(C), (g)(4); 42 C.F.R. § 488.26 (c)(1); and investigate complaints of resident neglect and abuse and noncompliance with federal standards, 42 C.”

Avon Nursing & Rehab. v. Azar (S.D.N.Y. 2023). “” 42 C.F.R. § 488.26 (c)(1). These surveys—and the statutes and regulations governing them—are the focus of the parties’ dispute in this matter.”

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