[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR483.30]



[Page 535-537]

 

                         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.  483.30  Nursing services.



    The facility must have sufficient nursing staff to provide nursing 

and related services to attain or maintain the highest practicable 

physical, mental, and psychosocial well-being of each resident, as 

determined by resident assessments and individual plans of care.

    (a) Sufficient staff. (1) The facility must provide services by 

sufficient numbers of each of the following types of personnel on a 24-

hour basis to provide nursing care to all residents in accordance with 

resident care plans:

    (i) Except when waived under paragraph (c) of this section, licensed 

nurses; and

    (ii) Other nursing personnel.

    (2) Except when waived under paragraph (c) of this section, the 

facility must designate a licensed nurse to serve as a charge nurse on 

each tour of duty.

    (b) Registered nurse. (1) Except when waived under paragraph (c) or 

(d) of this section, the facility must use the services of a registered 

nurse for at least 8 consecutive hours a day, 7 days a week.

    (2) Except when waived under paragraph (c) or (d) of this section, 

the facility must designate a registered nurse to serve as the director 

of nursing on a full time basis.



[[Page 536]]



    (3) The director of nursing may serve as a charge nurse only when 

the facility has an average daily occupancy of 60 or fewer residents.

    (c) Nursing facilities: Waiver of requirement to provide licensed 

nurses on a 24-hour basis. To the extent that a facility is unable to 

meet the requirements of paragraphs (a)(2) and (b)(1) of this section, a 

State may waive such requirements with respect to the facility if--

    (1) The facility demonstrates to the satisfaction of the State that 

the facility has been unable, despite diligent efforts (including 

offering wages at the community prevailing rate for nursing facilities), 

to recruit appropriate personnel;

    (2) The State determines that a waiver of the requirement will not 

endanger the health or safety of individuals staying in the facility;

    (3) The State finds that, for any periods in which licensed nursing 

services are not available, a registered nurse or a physician is 

obligated to respond immediately to telephone calls from the facility;

    (4) A waiver granted under the conditions listed in paragraph (c) of 

this section is subject to annual State review;

    (5) In granting or renewing a waiver, a facility may be required by 

the State to use other qualified, licensed personnel;

    (6) The State agency granting a waiver of such requirements provides 

notice of the waiver to the State long term care ombudsman (established 

under section 307(a)(12) of the Older Americans Act of 1965) and the 

protection and advocacy system in the State for the mentally ill and 

mentally retarded; and

    (7) The nursing facility that is granted such a waiver by a State 

notifies residents of the facility (or, where appropriate, the guardians 

or legal representatives of such residents) and members of their 

immediate families of the waiver.

    (d) SNFs: Waiver of the requirement to provide services of a 

registered nurse for more than 40 hours a week. (1) The Secretary may 

waive the requirement that a SNF provide the services of a registered 

nurse for more than 40 hours a week, including a director of nursing 

specified in paragraph (b) of this section, if the Secretary finds 

that--

    (i) The facility is located in a rural area and the supply of 

skilled nursing facility services in the area is not sufficient to meet 

the needs of individuals residing in the area;

    (ii) The facility has one full-time registered nurse who is 

regularly on duty at the facility 40 hours a week; and

    (iii) The facility either--

    (A) Has only patients whose physicians have indicated (through 

physicians' orders or admission notes) that they do not require the 

services of a registered nurse or a physician for a 48-hours period, or

    (B) Has made arrangements for a registered nurse or a physician to 

spend time at the facility, as determined necessary by the physician, to 

provide necessary skilled nursing services on days when the regular 

full-time registered nurse is not on duty;

    (iv) The Secretary provides notice of the waiver to the State long 

term care ombudsman (established under section 307(a)(12) of the Older 

Americans Act of 1965) and the protection and advocacy system in the 

State for the mentally ill and mentally retarded; and

    (v) The facility that is granted such a waiver notifies residents of 

the facility (or, where appropriate, the guardians or legal 

representatives of such residents) and members of their immediate 

families of the waiver.

    (2) A waiver of the registered nurse requirement under paragraph 

(d)(1) of this section is subject to annual renewal by the Secretary.

    (e) Nurse staffing information--(1) Data requirements. The facility 

must post the following information on a daily basis:

    (i) Facility name.

    (ii) The current date.

    (iii) The total number and the actual hours worked by the following 

categories of licensed and unlicensed nursing staff directly responsible 

for resident care per shift:

    (A) Registered nurses.

    (B) Licensed practical nurses or licensed vocational nurses (as 

defined under State law).

    (C) Certified nurse aides.

    (iv) Resident census.

    (2) Posting requirements. (i) The facility must post the nurse 

staffing data



[[Page 537]]



specified in paragraph (e)(1) of this section on a daily basis at the 

beginning of each shift.

    (ii) Data must be posted as follows:

    (A) Clear and readable format.

    (B) In a prominent place readily accessible to residents and 

visitors.

    (3) Public access to posted nurse staffing data. The facility must, 

upon oral or written request, make nurse staffing data available to the 

public for review at a cost not to exceed the community standard.

    (4) Facility data retention requirements. The facility must maintain 

the posted daily nurse staffing data for a minimum of 18 months, or as 

required by State law, whichever is greater.



[56 FR 48873, Sept. 26, 1991, as amended at 57 FR 43925, Sept. 23, 1992; 

70 FR 62073, Oct. 28, 2005]