Every skilled nursing facility that is certified to provide care to Medicare and Medicaid beneficiaries must comply with both Massachusetts State regulations as well as Federal Requirements of Participation and all applicable local laws, regulations, codes, and according to professional standards.


To obtain information on State regulations for Long-Term Care Facilities




In October 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule revising the Medicare and Medicaid Requirements of Participation (RoP) for nursing centers. This represents the first comprehensive revision to the regulations since 1991. The implementation of these new requirements will occur in 3 phases.

Phase 1: effective November 28, 2016

Phase 2: effective November 28, 2017

Phase 3: effective November 28, 2019

In addition, the CMS implemented a new survey process effective November 28, 2017. The New LTC Survey Process is resident-centered, which means resident-specific concerns identified through resident observations and resident or representative interviews are emphasized. The New LTC Survey Process provides as much structure as possible to ensure consistency while allowing surveyors the autonomy to make decisions based on their expertise and judgment.

The survey protocols and interpretive guidelines serve to clarify and/or explain the intent of the regulations. All surveyors are required to use them in assessing compliance with Federal requirements.  Deficiencies are based on violations of the regulations, which are to be based on observations of the nursing home’s performance or practices.

CMS Policy & Memos to States and Regions

CMS Training Resources

  • CMS Provider Training Video

    This one-hour training video for providers explains the rationale for adopting a new survey process, detailed guidance on how to complete the “Matrix for Providers” (resident roster), and key changes to regulatory requirements applicable to nursing homes, such as antibiotic stewardship.

  • CMS Topical Training Videos for Surveyors and Providers

    The full list of CMS videos created for the training of state survey staff on the Long Term Care Survey Process is provided below. Providers may also access each of these videos by clicking on the individual video title and slides or by clicking the link above and selecting “Launch the Course.” Depending upon the settings of your computer, it may be necessary to access these videos via Google Chrome.


CMS survey-related forms

Use these links to access fillable versions of the CMS forms that must be completed during the survey:


Other Resources


For additional information regarding Regulatory or Survey, please contact Helen Magliozzi, Director of Regulatory Affairs.