[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR483.5]



[Page 506-508]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table 

of Contents

 

          Subpart B_Requirements for Long Term Care Facilities

 

Sec. 483.5  Definitions.



    (a) Facility defined. For purposes of this subpart, facility means a 

skilled nursing facility (SNF) that meets the requirements of sections 

1819(a), (b), (c), and (d) of the Act, or a nursing facility (NF) that 

meets the requirements of sections 1919(a), (b), (c), and (d) of the 

Act. ``Facility'' may include a distinct part of an institution (as 

defined in paragraph (b) of this section and specified in Sec. 440.40 

and Sec. 440.155 of this chapter), but does not include an institution 

for the mentally retarded or persons with related conditions described 

in Sec. 440.150 of this chapter. For Medicare and Medicaid purposes 

(including eligibility, coverage, certification, and payment), the 

``facility'' is always the entity that participates in the program, 

whether that entity is comprised of all of, or a distinct part of, a 

larger institution. For Medicare, an SNF (see section 1819(a)(1) of the 

Act), and for Medicaid, an NF (see section 1919(a)(1) of the Act) may 

not be an institution for mental diseases as defined in Sec. 435.1009 

of this chapter.

    (b) Distinct part--(1) Definition. A distinct part SNF or NF is 

physically distinguishable from the larger institution or institutional 

complex that houses it, meets the requirements of this paragraph and of 

paragraph (b)(2) of this section, and meets the applicable statutory 

requirements for SNFs or NFs in sections 1819 or 1919 of the Act, 

respectively. A distinct part SNF or



[[Page 507]]



NF may be comprised of one or more buildings or designated parts of 

buildings (that is, wings, wards, or floors) that are: In the same 

physical area immediately adjacent to the institution's main buildings; 

other areas and structures that are not strictly contiguous to the main 

buildings but are located within close proximity of the main buildings; 

and any other areas that CMS determines on an individual basis, to be 

part of the institution's campus. A distinct part must include all of 

the beds within the designated area, and cannot consist of a random 

collection of individual rooms or beds that are scattered throughout the 

physical plant. The term ``distinct part'' also includes a composite 

distinct part that meets the additional requirements of paragraph (c) of 

this section.

    (2) Requirements. In addition to meeting the participation 

requirements for long-term care facilities set forth elsewhere in this 

subpart, a distinct part SNF or NF must meet all of the following 

requirements:

    (i) The SNF or NF must be operated under common ownership and 

control (that is, common governance) by the institution of which it is a 

distinct part, as evidenced by the following:

    (A) The SNF or NF is wholly owned by the institution of which it is 

a distinct part.

    (B) The SNF or NF is subject to the by-laws and operating decisions 

of a common governing body.

    (C) The institution of which the SNF or NF is a distinct part has 

final responsibility for the distinct part's administrative decisions 

and personnel policies, and final approval for the distinct part's 

personnel actions.

    (D) The SNF or NF functions as an integral and subordinate part of 

the institution of which it is a distinct part, with significant common 

resource usage of buildings, equipment, personnel, and services.

    (ii) The administrator of the SNF or NF reports to and is directly 

accountable to the management of the institution of which the SNF or NF 

is a distinct part.

    (iii) The SNF or NF must have a designated medical director who is 

responsible for implementing care policies and coordinating medical 

care, and who is directly accountable to the management of the 

institution of which it is a distinct part.

    (iv) The SNF or NF is financially integrated with the institution of 

which it is a distinct part, as evidenced by the sharing of income and 

expenses with that institution, and the reporting of its costs on that 

institution's cost report.

    (v) A single institution can have a maximum of only one distinct 

part SNF and one distinct part NF.

    (vi) (A) An institution cannot designate a distinct part SNF or NF, 

but instead must submit a written request with documentation that 

demonstrates it meets the criteria set forth above to CMS to determine 

if it may be considered a distinct part.

    (B) The effective date of approval of a distinct part is the date 

that CMS determines all requirements (including enrollment with the 

fiscal intermediary (FI)) are met for approval, and cannot be made 

retroactive.

    (C) The institution must request approval from CMS for all proposed 

changes in the number of beds in the approved distinct part.

    (c) Composite distinct part--(1) Definition. A composite distinct 

part is a distinct part consisting of two or more noncontiguous 

components that are not located within the same campus, as defined in 

Sec. 413.65(a)(2) of this chapter.

    (2) Requirements. In addition to meeting the requirements of 

paragraph (b) of this section, a composite distinct part must meet all 

of the following requirements:

    (i) A SNF or NF that is a composite of more than one location will 

be treated as a single distinct part of the institution of which it is a 

distinct part. As such, the composite distinct part will have only one 

provider agreement and only one provider number.

    (ii) If two or more institutions (each with a distinct part SNF or 

NF) undergo a change of ownership, CMS must approve the existing SNFs or 

NFs as meeting the requirements before they are considered a composite 

distinct part of a single institution. In making such a determination, 

CMS considers whether its approval or disapproval of a composite 

distinct part promotes the effective and efficient use of public



[[Page 508]]



monies without sacrificing the quality of care.

    (iii) If there is a change of ownership of a composite distinct part 

SNF or NF, the assignment of the provider agreement to the new owner 

will apply to all of the approved locations that comprise the composite 

distinct part SNF or NF.

    (iv) To ensure quality of care and quality of life for all 

residents, the various components of a composite distinct part must meet 

all of the requirements for participation independently in each 

location.



[68 FR 46071, Aug. 4, 2003]