University of Minnesota Long Term Care Resource Center
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Administration

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States
Complete Transcript of State Requirements on Administration (PDF)

Federal Regulations & Related F-tags for 483.75 Applicable Federal Regulation
Administration | F490
(a) Licensure | F491
(b) Compliance | F92
(c) Relationships to Other Regulations | F492
(d) Governing Body | F493
(e) Required Training of Nurse Assistants
(2) General Rules | F493-F497
(f) Proficiency of Nurse Aides | F 498
(g)Staff Qualifications | F499
(h) Use of Outside Resources | F500
(i) Medical Director | F501
(j) Laboratory Services | F502-F507
(k) Radiology/Diagnostic Services | F508-F513
(l) Clinical Records | F514-F516
(m) Disaster Preparedness | F517-F518
(n) Transfer Agreement | F519
(o) Quality Assessment and Assurance | F520-F521
(p) Disclosure of Ownership | F522
(q) Required Training of Feeding Assistants | None
  • 483.75 Administration

  • 483.30 Nursing Services

  • 483.35 Dietary Services

  • 483.40 Physician Services

  • 483.45 Special Rehabilitation Services
  • Description of Federal Requirements    (TOP)   (NEXT)

    The Federal regulation on Administration (483.75), the last of the group of Federal regulations for nursing-homes, deals with an assortment of topics, loosely related to administration and management of resources.  It is, therefore, one of the longest of the federal regulations, with 16 main sections, a-p, and many sub-parts.  The umbrella requirement for the entire regulation is that the nursing home “must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”

    Part (a) requires that the nursing home be licensed under any applicable State and local laws, Part (b) that it offer services in accordance with all applicable, Federal, State, and local laws, regulations, and codes, and “accepted professional standards and principles that apply to professionals working in a nursing home;” and Part  (c), that it meet applicable sections of other Federal Health and Human Services regulations; specifically cited are HHS rules on nondiscrimination on the basis of race, color, or national origin, handicap, and age; protection of human subjects; and prohibition of fraud and abuse.  Under Part (d), a governing body must be established with legal responsibility for policies governing the facility and appointing an administrator; the administrator must be licensed by States that so require, and is responsible for the management of the facility.

    Part (e), called required training of nursing aides, is a lengthy section referring to training and competency, registry verification, required retraining, and in-service education.   First, a definition section defines licensed health practitioner to include a physician, physician assistant, nurse practitioner, physical therapist, occupational therapist, speech therapist, physical or occupational therapist assistant, registered professional nurse, licensed practical nurse, or licensed or certified social worker.  By default nurse aide is defined as any individual “providing nursing or nursing-related services” to residents in a facility who are not licensed health professionals (as defined above), a registered dietician, or volunteers who provide such services without pay.  Then the general rule is enunciated that the facility must not use any person as a nurse’s aide on a full-time basis for more than four months unless they are trained in a State-approved training program and competent.  Before hiring a nurse’s aide, the facility must verify that competence through registry verification or proof that the applicant is currently enrolled in an approved course or recently completed one.  The facility also must check information about that applicant from all existing State registries.  If for 24 consecutive months since training and competency examination, the individual has not been employed as a nurse’s aide, a new training and competency evaluation or a new competency examination must be completed.  Each facility must review the performance of each nurse’s every 12 months, and must provide regular in-service education based on this review. The in-service education must be sufficient to ensure continuing competence but at least 12 hours per year.  It must address any areas of weakness as shown in the performance reviews, and it may address special needs of current residents.  If the nurse’s aides are caring for residents with cognitive impairment, they must receive continuing education about that topic.  A brief Part (f) requires the facility to ensure that nurse’s aides can demonstrate “competency I skills and techniques necessary to care or resident’s needs as identified through resident assessments and described in the plan of care.

    Part (g) requires that the facility employ on a full-time, part-time, or consultant basis all professionals needed to carry out all the Federal nursing home regulations and that these professionals be licensed, certified, or registered as required by the particular State laws.  Part (h), refers to use of outside resources, essentially requiring that professionals and professional services arranged under contract must meet prevailing standards, and that, in written contractual agreements, the facility must undertake responsibility for meeting professional standards for all those working in the facility and ensuring the timeliness of services.  Part (i) requires that the facility designate a medical director who is responsible for implementing resident care policies, and coordinating medical care in the nursing home. Part (j) sets up standards for providing or obtaining laboratory services (including blood bank and transfusion services, if provided in the facility), clarifies that all laboratory services provided or obtained are under order from the attending physician, that the facility assist residents as necessary to be transported for such outside services, and that the facility notify the physician promptly of results and file the laboratory reports in the resident’s records.  Part (k) specifies parallel standards for providing or obtaining radiology and diagnostic services under physician orders.  Part (l) relates toclinical records, requiring that quires the facility maintain records in accordance with professional standards that are complete, accurate, readily accessible, and systematically organized.  They must be retained for the period required by the State or for 5 years if the State lacks such standard.  The records must be safeguarded against loss, destruction, or unauthorized use, and be held confidentially except for specified required releases for transfer to other facilities, legal, or insurance reasons.  This section states five requirements for the content of the records: sufficient identifying information to identify the resident, a record of the resident’s assessments, the plan of car and the services provided, the results of any preadmission screening conducted by the State, and   progress notes.  It should also be noted that in addition to the discussion in the Administration regulation in Subpart B (which contains all enumerated Federal Regulations), a separate Subsection D contains Requirements That Must be met by States and State Agencies: Nurse Aide Training and Competency Evaluation, and Paid Feeding Assistants deals specifically with training, evaluation, and curriculum requirements for CNAs and curriculum requirements for paid feeding assistants.

    Part (m) requires disaster and emergency preparedness.  First, the facility must have “detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents;” and, second, the facility must train all employees in emergency procedures upon employment, periodically review the procedures with existing staff, and carry out unannounced staff fire drills using these procedures. 

    Part (n) requires that the facility have written transfer agreements with one or more hospitals in the area approved for Medicare and Medicaid to reasonably assure that residents in need of care will have timely transfer to hospital accompanied by appropriate information.  A facility will have met this requirement if it has made good faith attempts to enter into agreement with a hospital close enough to the facility to make transfer feasible.

    Part (o) requires that the facility maintain a quality assessment and assurance committee that consists of the director of nursing services, a physician designated by the facility, and at least 3 other facility staff members; that the committee meet at least quarterly to determine which quality assessment and assurance activities are needed, and develop plans of actions related to correct identified deficits in quality.  Information derived from quality assurance activities are explicitly protected from use against the facility in legal or regulatory activity.  Neither State nor the Secretary of the U.S. Department of Health and Human Services may require disclosure of the records of the committee (except as proof of compliance with the quality assurance regulation) nor may they use good faith efforts to correct quality deficits as a basis for sanctioning the facility. 

    Part (p) requires that the facility disclose its ownership, and provide the State licensing agency with information about the following changes: controlling ownership; officers, directors, agents, or managing employees; the corporation, association, or other company responsible for the facility management; and the facility administrator or director of nursing.  Such notice must include the names of the new individuals or companies assuming the roles after the change. 

    Finally, part (q) specifies that nobody shall work in a facility as a paid feeding assistant unless he/she has completed a state-mandated training course.

    Comparison of State Requirements    (TOP)   (NEXT)

    The Federal regulation on Administration is multifaceted that State variation occurs in all of its subparts.   The Table below simply indicates which parts of the general rule show variation by State.

    We have prepared comparative analyses, complete with their own narratives, tables, and summary PDF documents for many of the subparts in additional sections.  These include: an analysis of  State rules relating to licensure, compliance, governance; ownership disclosure (found in a-d and p of the Federal regulation; an analysis of State rules relating to CNA training, registries, and (found in e and f of the Federal regulation), a separate analysis of State regulations on in-service education and orientation (elaborations of the brief section (e) (8) of the federal regulation); an analysis of State regulations on disaster/emergency preparedness (section m of the Federal regulations); and an analysis of State rules on quality assurance (Section o of the federal regulations. 

    Considerable additional content is supplied in State regulations regarding clinical records (section l); such variation concerns the length of time they are stored and the content requirements. 

    Table Comparing States      (TOP)

    Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Administration by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Administration.

    483.75 Administration

    State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
    Alabama Yes Ownership disclosure amplification (including time period for reporting); accounting standards; acting administrator during latter’s absence; person to laboratory (reference to bedside glucose testing); 24 hour time period for reporting fires or disasters.
    Alaska Yes Medical director (experimental drug protocols); duties of administrator.
    Arizona Yes Duties of administrator; limitations in serving as both hospital and NH administrator; ownership changes (timing of reporting);  disaster and emergency preparedness (map of evacuation posted at nursing stations); medical director role; quality assurance.
    Arkansas Yes Administrator hours on premises and substitution plans; Administrators-in-Training; Written policies maintained by administrator.
    California Yes Administrator role; administrator responsibility for multiple facilities; administrator coverage; governance structure (3 required 
    committees).
    Colorado Yes Quality assurance; administrator responsibility; facility plan of organization; staffing plan; department structure; staff development (coordinator, program, documentation); records on employees; staff identification badges; medical director duties.
    Connecticut Yes Duties of governing body; Administrator (credentials, application process & references; duties; coverage based on size of facility; prohibitions against serving as DON); Medical director (role, organized medical staff); Nurse’s Aide training and competency (including instructor credentials); Registries (foreign training); Clinical records (contents, format details, retaining 10 years).
    Delaware Yes Nurse aides trained outside of Delaware; Nurse aide role and function; nurse aide competencies; detailed curriculum; instructor credentials.
    District of Columbia Yes Administrative management, requirements, fees and policies for personnel and resident care.
    Florida Yes License to provide adult day care or respite (part of Gold Seal program); Gold Seal quality recognition program, in general; Clinical Records (includes records of all services provided by nurse’s aides; Fiscal records; Reporting requirements on turnover, & vacant beds; Internal quality assurance and risk management program; State program of nurse quality monitors (includes quality assurance early warning system; Nurse aide training and competency; Confidentiality and conditions of disclosure of QA activities, risk management,  and State monitoring.
    Georgia Yes Administrator (multiple facilities); Policies; Personnel folders; Home and premises only used for purposes permitted.
    Hawaii Yes Disaster preparedness; Clinical records; Other records that facility must keep.
    Idaho Yes Disclosures of ownership; Administrator (hospital administrators as NH administrator; backup; duties);
    Illinois Yes Disclosure of ownership (change of administrator disclosed in 5 
    days); Administrator (backup, duties of administrator); nurse’s aide registry and employment requirements; Nurse’s aide training; Disaster preparedness; Medical director.
    Indiana Yes Administrator (notification of change, substitute, role); Policies; Notifications; Disaster preparedness; Transfer agreements with hospitals; Medical Director role; Screening of prospective employees; Nurse’s aide training and competency (curriculum); in-service training.
    Iowa Yes Administrator (more than one facility, provision administrator, temporary backup, assistant administrator, roles); Medical director (roles).
    Kansas Yes Licensure (detailed instructions and criteria for applications); disclosures of ownership; disclosures on construction plans and alterations thereto; Administrator (written job description; criteria for more than one facility; backup during absences); Required reports on staff and residents; Smoking policy; Clinical Records (contents, clinical record staff); Disaster preparedness.
    Kentucky Yes Governance (policies); Personnel job descriptions; In-service education.
    Louisiana Yes Disclosures of change in administrator; Administrator backup; Personnel records; Outside services (annual verification of credentials); Written policies; In-service training; disaster preparedness.
    Maine Yes Administrator (exemption of hospital-based, substitute for absence; emergency administrator, coverage; shared administrator, quality assurance (reporting, utilization review requirements), Professional policies; Employment conditions (including grievances, employee records, time schedule); In-service training.
    Maryland Yes Administrator (multiple facilities, relief,  absenteeism, character); Voluntary admission ceiling policies; Employee records; Orientation (supportive personnel orientation); Medical director (a very detailed section on credentials, role, reporting, QA; duties of others in relationship to medical director, among other elements); Training (curriculum); Registry; Quality assurance (committee composition, duties, elements of QA plan, including incident reporting).
    Massachusetts Yes Administrator (coverage, alternate, role); Policy responsibility of administrator and licensee; Employee records and employee health; incidence reporting; licensure (voluminous material regarding license applications,  renewals, denial or loss of license, appeals; non-transferability of license, posting of license, name of facility, transfer of ownership; intent to close).
    Michigan Yes Administrator (coverage); Nurse aide competency (random competency exams by surveyors).
    Minnesota Yes Administrator, (absence requirements, roles, medical director).
    Mississippi Yes Administrator (alternative in his/her absence, responsibilities); Criminal checks (definition of employee for purpose; exemption of students on signing affidavit); Organizational chart; Administrator (alternative for absences, age, character); after 2001, a mandatory 2-day mentoring by the Survey & Certification agency.
    Missouri Yes General certification requirements, general license 
    requirements, hiring restrictions - good cause waiver, Alzheimer's  demonstration projects,nursing facility quaility of care improvement  program, extensive training program for nursing assistants requirements, 
    fire safety standards for new and existing ntermediate care and skilled  nursing facilities and administration and resident care requirements.  .
    Montana Yes CNA competence and testing; Allowable costs; Reimbursable services under Medicaid; License (application and renewal, licensing food establishment); Nurse aide training (curriculum).
    Nebraska Yes Licensee responsibility; Administrator (coverage; multiple facility; notification of changes; responsibility; Staff credentials; Employee health; disaster preparedness.
    Nevada Yes Quality assurance; Incident reporting; Administrator (coverage, alternate for absences, responsibilities); quality assurance (core team to participate, responsibility, procedures,  reporting and records).
    New Hampshire Yes Administrator (coverage, alternate in absence, responsibility); Personnel and staffing records; Employee health; Nurse aide registry.
    New Jersey Yes Administrator (coverage, multiple, vacancy, qualifications); Mandatory job descriptions; Advisory staff; Mandatory resident communications; Staff development (curriculum on communication, topics, frequency, Medical director; Emergency preparedness (smoking policies, fire drills, evacuation procedures, emergency supplies); Quality assurance (monitoring of QIs, source of information includes gathering information from residents and visitors); Periodic satisfaction surveys of families; Clinical records.
    New Mexico Yes Administrator (coverage, multiple facilities, temporary replacement).
    New York Yes Radiology services; Clinical records; Administrator (role, setting an example for accessibility and communication, coverage, multiple facilities, vacancy; temporary acting administrator, responsibilities); RUGS classification system (informing residents of it); Governing body available to meet with resident council at least 3 times a year; Orientation (includes volunteers, private duty personnel and consultants; content of orientation); Employee health; Organization chart and policy manual; Nurse aide training (instructors, curriculum, competency testing); Quality assurance (committee composition, procedures; selection of topics and residents for review.
    North Carolina Yes Administrator (full-time).
    North Dakota Yes Administrator (alternatives in absence), Personnel policies (job descriptions); Quality improvement.
    Ohio Yes Nursing-related services (definition); Nurse’s aide training; Competency exam (prohibition of charging aide for it); Orientation; In-service (including for specialty units); Medical director; Disaster preparedness (training, evacuation, fire drills; Quality assurance (monitoring trends).
    Oklahoma Yes Administrator (alternative in absence); Administrative records (includes copies of all contracts, resident council records, transfer agreement, transportation agreements, etc); Job descriptions; Nursing policy and procedure manual; Employee health; Inventory of residents possessions; Quality assurance (committee composition); Medical director; .Quality assurance.
    Oregon Yes Employment (reference check, rules for prohibition of employment; Consultant report; Quality assurance (policies required, procedures for audits; Administrator (multiple facilities; alternative for absences; Medical director; Clinical records (filing, content, format); Orientation (topics); In-services training.
    Pennsylvania Yes Governance (by-laws); Administrator (multiple facilities, coverage, alternative for absences; responsibilities); Clinical Records (retention for 7 years, record content).
    Rhode Island Yes Governing body (conflict of interest policy); Quality assurance; Administrator (coverage, alternative for absences, responsibilities); Notification of labor actions; Medical director; Criminal records checks (disqualifying offenses); Employees (job descriptions, employee health, employee records); In-service training (content); employee photo IDs; Professional license verification; Clinical records (content); Resident care policies; Disaster preparation.
    South Carolina Yes Administrator (coverage, hours, alternative in absence; Employee health records; Voluntary workers and private sitters.
    South Dakota Yes Administrator (credentials, alternative during absences, Personnel policies; Employee health; Emergency preparedness.
    Tennessee Yes Administrator (hours and coverage; hospital based administrator; unexpected loss of administrator; notification of loss, temporary replacement policies); replacement notice and policies; Criminal checks; Policies and procedures (including pain assessment and end-of-life care; Quality improvement; Medical director; Disaster preparedness (extremely detailed section); Nurse aide training and competency testing.
    Texas Yes Licensure (application, building approval, ownership changes; Alzheimer’s programs; disclosures, renewal, revocation); Governing body; Administrator (coverage).
    Utah Yes Administrator (only one facility; alternative in absence, responsibilities); Contracts; Policies; Employee records and employee health; Volunteers; Quality assurance; Clinical and other records; Emergency preparedness.
    Vermont Yes Licensure; Quality assurance (committee composition).
    Virginia Yes Bed capacity; Employee records and employee health; Administrator (full time; changes and notifications, alternative for absences); Administrative policies; Quality assurance (committee composition, procedures); Medical director; Disaster preparedness; In-service training (content, recording.
    Washington Yes Administrator (coverage, alternate for absences, multiple facilities); Policies (written policies, whistle blower protection); Notifications and mandated reports; Name badges (residents have sufficient information to distinguish types of nurses(; Staff development program; Clinical and other records (content, retain 8 years; qualifications of record personnel, index system, legibility); Disaster preparedness; Quality assurance (must seek out input from resident and family groups); Criminal checks (disqualifying offences,  disclosure to staff member or applicant).
    West Virginia Yes Disaster training; Quality assurance.
    Wisconsin Yes Administrator (multiple facilities, alternate in absence, termination, notice of changes, temporary replacement); Employee and volunteer health; Orientation; In-service (nursing, dietary); Employee records; Clinical records; Social work and activity records; Administrative records; Disaster preparedness.
    Wyoming Yes Administrator (coverage, multiple facilities, alternate for absences; changes and temporary administrator, notification of changes); Policies; Employee health; Staff development.

    Complete Transcript of State Requirements on Administration    (TOP)