Nursing homes across the country must comply with federal as well as state regulations in order to receive federal funding. In Indiana, the state regulations mirror the federal regulations, but some states have even tougher laws.
The Indiana State Department of Health (ISDOH) has a contractual responsibility to the Centers for Medicare and Medicaid Services (CMS) to enforce the federal minimum standards, and has the authority to enforce state regulations related to the licensure, operation, and reimbursement of nursing home care under the Medicaid program.
The state and federal regulations assist ISDOH surveyors to conduct their investigations (surveys) of a nursing home. The surveyors are concerned with potential and actual outcomes of care, and focus on such care during their survey process to ensure nursing homes are achieving the best practicable quality of life for residents, as well as preventing accidents and adverse events.
If a nursing home is found to be out of compliance with state and federal regulations and does not remedy deficiencies, it can be put into a “decertification track,” meaning that it will lose its opportunity to receive Medicare and Medicaid funding to pay for resident care. The nursing home will also be subject to heavy fines and lose its right to conduct the certified nursing assistant (CNA) training course. Nursing homes can also lose their state license to operate if they continue to fail to comply with regulations.
The state and federal regulations govern the following main areas of resident care:
- Resident rights
- The administration and management of health facilities
- Sanitation and safety standards
- Assessment of resident needs
- Medical and nursing services
- Food and nutrition services
- Infection control
- Activities and social services programs
- Clinical records