Long-term care facilities participating in Medicare and Medicaid must meet certain federal requirements necessary to assure the health and safety of individuals to whom services are furnished. There are specific federal regulations related to the Quality Measures. This section contains information, published by the Centers for Medicare, & Medicaid Services (CMS), for use in the long term care inspection process. The information included in this section is taken from the federal regulations, guidance to surveyors, and survey protocols. These items are used by state and federal regional office personnel to conduct surveys of long term care facilities for compliance with the requirements at 42 CFR Part 483 Subpart B to receive payment under Medicare or Medicaid. Both facility staff members and the state survey agency can use this information, to provide consistent quality care for the resident.

The federal regulations related to the Quality Measures can be categorized according to three clinical steps: assessment, care planning, and delivery of care. Some of the Quality Measures are governed by federal regulations that are very specific to the clinical issue. Other Quality Measures are addressed under federal regulations that are more general in nature. This document provides an overview of pertinent regulations and the related guidance to surveyors regarding pain assessment and management.

Guidance to surveyors, survey probes and procedures direct the surveyors in the evaluation of care provided by the facility. Guidance to surveyors contains authoritative interpretations of statutory and regulatory requirements and is used to make determinations about a provider’s compliance with requirements. The guidance merely defines or explains the relevant statutes and regulations and does not impose any additional requirement. Survey protocols, probes, and procedures are different for each associated federal regulation. Some regulations have specific “investigative protocols,” others do not.

When used with the Quality Measures, the regulations and the survey process become a powerful tool for effecting changes in care systems that provide for improved delivery of care. Long-term care providers must have a thorough knowledge of the federal requirements in order to comply with the regulations and ultimately to provide for the health and safety of residents. An understanding of the survey process will help providers evaluate the quality of care delivered and target quality improvement efforts.