C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 488—SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES › Subpart E—Survey and Certification of Long-Term Care Facilities

42 C.F.R. § 488.301

Definitions

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As used in this subpart—

Abbreviated standard survey means a survey other than a standard survey that gathers information primarily through resident-centered techniques on facility compliance with the requirements for participation. An abbreviated standard survey may be premised on complaints received; a change of ownership, management, or director of nursing; or other indicators of specific concern. Abbreviated standard surveys conducted to investigate a complaint or to conduct on-site monitoring to verify compliance with participation requirements are subject to the requirements of § 488.332. Other premises for abbreviated standard surveys would follow the requirements of § 488.314.

Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.

Deficiency means a SNF's or NF's failure to meet a participation requirement specified in the Act or in part 483, subpart B of this chapter.

Dually participating facility means a facility that has a provider agreement in both the Medicare and Medicaid programs.

Extended survey means a survey that evaluates additional participation requirements subsequent to finding substandard quality of care during a standard survey.

Facility means a SNF or NF, or a distinct part SNF or NF, in accordance with § 483.5 of this chapter.

Immediate family means husband or wife; natural or adoptive parent, child or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild.

Immediate jeopardy means a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent.

Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.

Noncompliance means any deficiency that causes a facility to not be in substantial compliance.

Nurse aide means an individual, as defined in § 483.5 of this chapter.

Nursing facility (NF) means a Medicaid nursing facility.

Paid feeding assistant means an individual who meets the requirements specified in § 483.60(h)(1) of this chapter and who is paid to feed residents by a facility, or who is used under an arrangement with another agency or organization.

Partial extended survey means a survey that evaluates additional participation requirements subsequent to finding substandard quality of care during an abbreviated standard survey.

Skilled nursing facility (SNF) means a Medicare nursing facility.

Standard survey means a periodic, resident-centered inspection which gathers information about the quality of service furnished in a facility to determine compliance with the requirements for participation.

Substandard quality of care means one or more deficiencies related to participation requirements under § 483.10 “Resident rights”, paragraphs (a)(1) through (a)(2), (b)(1) through (b)(2), (e) (except for (e)(2), (e)(7), and (e)(8)), (f)(1) through (f)(3), (f)(5) through (f)(8), and (i) of this chapter; § 483.12 of this chapter “Freedom from abuse, neglect, and exploitation”; § 483.24 of this chapter “Quality of life”; § 483.25 of this chapter “Quality of care”; § 483.40 “Behavioral health services”, paragraphs (b) and (d) of this chapter; § 483.45 “Pharmacy services”, paragraphs (d), (e), and (f) of this chapter; § 483.70 “Administration”, paragraph (p) of this chapter, and § 483.80 “Infection control”, paragraph (d) of this chapter, which constitute either immediate jeopardy to resident health or safety; a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm.

Substantial compliance means a level of compliance with the requirements of participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm.

Validation survey means a survey conducted by the Secretary within 2 months following a standard survey, abbreviated standard survey, partial extended survey, or extended survey for the purpose of monitoring State survey agency performance.

[59 FR 56238, Nov. 10, 1994, as amended at 68 FR 55539, Sept. 26, 2003; 81 FR 68871, Oct. 4, 2016; 82 FR 36635, Aug. 4, 2017]
Notes of Decisions
Cited in 89 cases (14 in the last 5 years), 1997–2026 · leading case: State Ex Rel. Protective Health Services State Department of Health v. Vaughn
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State Ex Rel. Protective Health Services State Department of Health v. Vaughn (2009) okla · cites it 6× “" [12] Section 1396(g)(1)(C) requires states to "investigate and make findings concerning neglect and abuse and misappropriation of resident property by a nurse aide of a resident in a nursing facility...." Misappropriation of resident property, as defined by the federal…”
Rosewood Care Center of Swanse v. Thomas E. Price (2017) ca7 · cites it 8× “§ 1395i-3(a); 42 C.F.R. § 488.301 , participating in Medicare and Medicaid as a provider.”
Shalala v. Illinois Council on Long Term Care, Inc. (2000) scotus · cites it 2× “§ 1395i—3(h); 42 CFR § 488.301 (1998); § 488.400 et seq.”
Sunshine Haven Nursing Operations, LLC v. United States Department of Health & Human Services, Centers for Medicare & Me (2014) ca10 · cites it 5× “and with accepted professional standards and principles which apply to professionals providing services in such a facility.”
Golden Living Center-Frankfort v. Secretary of Health & Human Services (2011) ca6 · cites it 3× “See 42 C.F.R. § 488.301 (substantial compliance is a “level of compliance with the requirements of participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm.”
Beverly Health & Rehabilitation Services, Inc. v. Thompson (2002) dcd · cites it 4× “) See also 42 C.F.R. § 488.301 . The protocol instructs surveyors that “[t]o help determine if a deficiency exists, look at the language of the requirement.”
Salmon v. Department of Public Health & Addiction Services (2002) conn · cites it 2× “These regulations specifically revised the original definition of “abuse” contained in 42 C.F.R. § 488.301 to read “[a]buse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.”
Florida Agency for Health Care Administration v. Bayou Shores SNF, LLC (In Re Bayou Shores SNF, LLC) (2016) ca11 “” 42 C.F.R. § 488.301 . The regulation only requires -that the nursing home’s noncompliance is likely to cause harm to "a resident.”
CLAIBORNE-HUGHES HEALTH CENTER v. Sebelius (2010) ca6 · cites it 2× “” 42 C.F.R. § 488.301 . Such a finding exposes the Medicare provider to a CMP ranging from $3,050 to $10,000 per day.”
United States Ex Rel. Absher v. Momence Meadows Nursing Center, Inc. (2014) ca7 “See 42 C.F.R. § 488.301 . The provision of non-compliant care can result in a variety of remedies or sanctions, including fines or even termination from the Medicare and Medicaid programs.”
Liberty Commons Nursing v. Leavitt (2008) ca4 · cites it 8× “(citing 42 C.F.R. § 488.301 ). In this case, the Secretary found that Petitioner failed to adequately supervise Resident in order to prevent her from eloping, in violation of 42 C.”
Bryn Mawr Care, Incorporated v. Kathleen Sebelius (2014) ca7 · cites it 3× “42 C.F.R. § 488.301 . Deficiencies are categorized alphabetically from “A” to “L” (minor to major) by scope (isolated, pattern, or widespread) and severity.”
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