The Federal Regulations for nursing homes, hospitals, and other types of healthcare facilities, as I mentioned before, are mostly located in the Code of Federal Regulations – Title 42. You will find this and the other Federal codes

The Federal Government has many manuals to help administer the Centers for Medicare and Medicaid Services (CMS) programs. These manuals provide valuable information related to Medicare and Medicaid and it offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. You will find the Internet version of these manuals here: Click on the words “Internet only manuals” and you will see more links to 22 items or manuals at this site. The online manuals are the official copies of the manual.

In order to help with consistency in surveying the various facilities around the nation, the regulations in CFR 42 which are related to those facilities were put into a manual. That manual is called the “State Operations Manual”  abbreviated “SOM”. When you hear a surveyor talking about the SOM, they are talking about this manual. In fact, when a surveyor is talking about the SOM, they are most likely talking about (or are referring to) a small portion of the SOM, called the appendices. The regulations and the interpretive guidance (IGs) to the regulations were placed in these appendices. On the page mentioned in the previous paragraph, you will see a list of publications. The SOM is publication 100-07.

The SOM has 8 chapters, a set of exhibits and a set of appendices, all of which are available on-line. Here is the list of chapters:

Chapter 1 – Program Background and Responsibilities [PDF, 207 KB]
Chapter 2 – The Certification Process [PDF, 1,167 KB]
Chapter 3 – Additional Program Activities [PDF, 433 KB]
Chapter 4 – Program Administration and Fiscal Management [PDF, 434 KB]

Chapter 5 – Complaint Procedures [PDF, 580 KB]
Chapter 6 – Special Procedures for Laboratories [PDF, 2,100 KB]
Chapter 7 – Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities [PDF, 1,639 KB]
Chapter 8 – Standards and Certification [PDF, 116 KB]
Exhibits Table of Contents [PDF, 348 KB]
Appendices Table of Contents [PDF, 57 KB]

As you can see, the SOM describes the background of the program, (who does it and why) and it gives the state Survey Agencies (SA) instructions on conducting surveys, including compliant investigations.

Most surveyors working in the field will be most familiar with Chapters 7, the exhibits, and the appendices. The appendices, as mentioned previously, have the guidance needed for each regulation. Each facility type or a portion thereof has been put into different appendices. There are currently 20 Appendices in use. They are:

A – Hospitals

AA – Psychiatric Hospitals

B – Home Health Agencies

C – Laboratories and Laboratory Services

D – Portable X-ray Service

E – Outpatient Physical Therapy or Speech Pathology Services

G – Rural Health Clinics

H – End Stage Renal Disease Facilities

I – Life Safety Code

J – Intermediate Care Facilities for Persons with Mental Retardation

K – Comprehensive Outpatient Rehabilitation Facilities

L – Ambulatory Surgical Services

M – Hospice

P – Survey Protocol for Long Term Care Facilities

PP – (We like to call it double P rather than PP)  Interpretive Guidelines for Long Term Care Facilities

Q – Immediate Jeopardy

R – Resident Assessment Instrument for Long Term Care Facilities

T – Swing Beds (no these are not beds on swings J)

U – Religious Nonmedical Healthcare Institutions

W – Critical Access Hospitals

As we go along in this site, you will get to learn more about each of these. These are not secret and any member of the public is able to view these and read them. They are to guide the investigations and surveys, and the facilities must follow them. Now that you are aware they are there, you have more power to protect yourself and your loved ones!


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