[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: 42CFR488.56]



[Page 669-670]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 488_SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES--Table of 

 

                     Subpart B_Special Requirements

 

Sec.  488.56  Temporary waivers applicable to skilled nursing facilities.



    (a) Waiver of 7-day registered nurse requirement. To the extent that 

Sec.  483.30 of this chapter requires any skilled nursing facility to 

engage the services of a registered nurse more than 40 hours a week, the 

Secretary may waive such requirement for such periods as he deems 

appropriate if, based upon documented findings of the State agency, he 

determines that:

    (1) Such facility is located in a rural area and the supply of 

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

the needs of individual patients therein,

    (2) Such facility has at least one fulltime registered nurse who is 

regularly on duty at such facility 40 hours a week, and

    (3) Such facility (i) has only patients whose attending physicians 

have indicated (through physicians' orders or admission notes) that each 

such patient does not require the services of a registered nurse for a 

48-hour period, or (ii) has made arrangements for a registered nurse or 

a physician to spend



[[Page 670]]



such time at the facility as is determined necessary by the patient's 

attending physician to provide necessary services on days when the 

regular fulltime registered nurse is not on duty.

    (4) Such facility has made and continues to make a good faith effort 

to comply with the more than 40-hour registered nurse requirement, but 

such compliance is impeded by the unavailability of registered nurses in 

the area.

    (b) Waiver of medical director requirement. To the extent that Sec.  

488.75(i) of this chapter requires any skilled nursing facility to 

engage the services of a medical director either part-time or full-time, 

the Secretary may waive such requirement for such periods as he deems 

appropriate if, based upon documented findings of the State agency, he 

determines that:

    (1) Such facility is located in an area where the supply of 

physicians is not sufficient to permit compliance with this requirement 

without seriously reducing the availability of physician services within 

the area, and

    (2) Such facility has made and continues to make a good faith effort 

to comply with Sec.  488.75(i) of this chapter, but such compliance is 

impeded by the unavailability of physicians in the area.



[39 FR 35777, Oct. 3, 1974. Redesignated and amended at 42 FR 52826, 

Sept. 30, 1977. Further redesignated and amended at 53 FR 23100, June 

17, 1988, and further amended at 56 FR 48879, Sept. 26, 1991; 57 FR 

43925, Sept. 23, 1992]