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SMQT Survey Content Standard Surveys Guaranteed Success Appendix: Overview of Skilled Nursing Facilities and Provider Regulations Definitions: - SNF: Skilled Nursing Facility - NF: Nursing Facility - SQC: Substandard Quality of Care Social Security Act - Section 1861(u) This section speci...

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  • August 15, 2024
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SMQT Survey Content Standard Surveys Guaranteed Success
Appendix: Overview of Skilled Nursing Facilities and Provider Regulations



Definitions:



- SNF: Skilled Nursing Facility

- NF: Nursing Facility

- SQC: Substandard Quality of Care




Social Security Act - Section 1861(u)

This section specifies the following entities as PROVIDERS:



- Hospitals

- Critical Access Hospitals (CAHs)

- Skilled Nursing Facilities (SNFs)

- Home Health Agencies (HHAs)

- Hospices

- Comprehensive Outpatient Rehabilitation Facilities (CORFs)




Social Security Act - Section 1835(a)(2)

This section includes additional providers if they meet the requirements of Section 1861(p)(4)(A):



- Clinics

- Rehabilitation Agencies

, - Public Health Agencies



Note: Community Mental Health Centers (CMHCs) are recognized as providers solely for partial
hospitalization services.




Suppliers That Must Meet Conditions for Coverage (CFCs) to Participate in Medicare:



Suppliers must comply with specific conditions for coverage (CfCs). Examples include:



- Portable X-ray Services

- Rural Health Clinics (RHCs)

- End Stage Renal Disease (ESRD) Facilities

- Physical Therapists in Independent Practice (PTIPs)

- Occupational Therapists in Independent Practice (OTIPs)

- Ambulatory Surgical Centers (ASCs)

- Organ Procurement Organizations (OPOs)



Suppliers Without Conditions for Coverage or Surveys:

The following entities do not have conditions for coverage or undergo surveys:



- Durable Medical Equipment (DME) Suppliers

- Pharmacies

- Prosthesis Suppliers

- Laboratories that meet CLIA requirements and participate in Medicare are considered suppliers.

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