Skilled nursing facility

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Physical rehabilitation after a disabling accident often requires the services of the skilled nursing facility.

A skilled nursing facility (SNF, pronounced like the English word "sniff"), as defined by the U.S. Social Security Act, is an institution or distinct part of an institution that provides skilled nursing care to residents or physical rehabilitation care to the injured, disabled, or ill.[1]

Qualifying as a SNF

The skilled nursing facility is primarily a designation driven by the Centers for Medicare and Medicaid Services (CMS) and its associated billing. To qualify, a SNF must meet certain requirements, including[1]:

  • "quality of life" requirements: must "promote maintenance or enhancement of the quality of life of each resident" and maintain a quality assessment and assurance program
  • "scope of services and activities" requirements: must draft and periodically assess a physician-guided plan of care for each resident that details resident needs and how they'll be met
  • "resident's assessment" requirements: "must conduct a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity," certified by a registered professional nurse or an individual approved by the State and performed at minimum once a year
  • "provision of services and activities" requirements: must supply physician-supervised nursing, specialized rehabilitative, medically-related social, pharmaceutical, dietary, emergency dental, and special mental services as well as "activities designed to meet the interests and the physical, mental, and psychosocial well-being of each resident"
  • training requirements: must set competency requirements for employees conducting nursing-related services, ensure those employees have completed a State-approved training and competency evaluation program, and provide regular in-service training and education programs to keep employees operating at a peak professional level


The skilled nursing facility was first referenced as an "extended care facility" or "extended-care facility" by Medicare with the passage of the Social Security Amendments of 1965 (which also created Medicare).[2] However, the Amendments of 1967 introduced the term "skilled nursing facility,"[3] and the Amendments of 1972 included "provisions which would conform Medicare and Medicaid requirements and procedures with respect to skilled nursing facilities (formerly called ECF’s under Medicare)."[4]

Legislation regarding these nursing facilities remained mostly unchanged until the Federal Nursing Home Reform Act (later known as Title 42 Part 483) from the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). Among other things, nursing facilities like the SNF were required to[5]:

  • emphasize quality of life and care to residents.
  • create and assess an individual care plan.
  • provide the right to remain in care even after a hospital stay and the right to choose a personal physician.
  • provide additional opportunities to residents with mental retardation or illness.
  • function under minimum federal standards or face even stricter penalties.

External links


  1. 1.0 1.1 "Title XVIII, Sec. 1819 - Requirements for, and Assuring Quality of Care in, Skilled Nursing Facilities". Compilation of the Social Security Laws. Social Security Administration. Retrieved 15 April 2014. 
  2. Cohen, Wilbur J.; Ball, Robert M. (September 1965). "Social Security Amendments of 1965: Summary and Legislative History" (PDF). Social Security Administration. Retrieved 16 April 2014. 
  3. "P.L. 90–248, Approved January 2, 1968 (81 Stat. 821)". Compilation of the Social Security Laws. Social Security Administration. Retrieved 16 April 2014. 
  4. Ball, Robert M. (March 1973). "Social Security Amendments of 1972: Summary and Legislative History" (PDF). Social Security Administration. p. 20. Retrieved 16 April 2014. 
  5. Turnham, Hollis. "Federal Nursing Home Reform Act from the Omnibus Budget Reconciliation Act of 1987 or simply OBRA ‘87 Summary" (PDF). North Carolina Department of Health and Human Services. Retrieved 16 April 2014.