Long-Term Care

Tip of the week: Understand the difference between a state and federal survey

Contemporary Long-Term Care Weekly, April 15, 2010

In reality, there is no major difference between state and federal surveys. Both are required as outlined under the federal regulations promulgated by CMS. The same forms are used and the same guidelines for monitoring participations requirement are followed. However, states often have their own health code and can provide citations for noncompliance with state regulatory requirements. Upon receipt of the Statement of Deficiencies form (CMS-2567 form) at the state survey office, if a federal regulation does not cover a particular area, state surveyors will often issue a state citation.

In addition, at times they will cite state and federal regulations that are equal, where you may have a federal citation and state citation that both deal with the same issue. Federal surveys will only provide citations for noncompliance on the federal level.

Most surveys in the United States are conducted by state regulatory departments, with federal surveys conducted by regional CMS offices. CMS mandates that a random sample of 5% of nursing homes should be surveyed annually by the federal regulatory group located at CMS. In the federal survey, the surveyors do not look at state regulatory requirements and instead concentrate only on federal regulations. There are two major types of federal surveys:

  • An observational survey is done along with the state survey group. The federal regulators’ role in this case is to work along with the state surveyors and monitor or observe that they are conducting the survey process consistent with federal regulatory guidelines, and to make sure they are applying the interpretive federal guidelines appropriately.
  • In a look-back survey, the federal survey team comes in after the state survey team; in other words, the facility goes through two separate surveys. The federal survey group surveys the facility to see whether their results are similar to those of the state survey team. If the surveyors in both groups are on the same page, there should be some consistency in the level and types of deficiencies they identify.

This is an excerpt from the HCPro book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

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