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Phase 3 of the Revised Federal Nursing Home Regulations

On October 4, 2016, the final regulations for nursing homes participating in the Medicare and/or Medicaid programs was published in the Federal Register. The regulations were effective on November 28, 2016 and were implemented in three phases. 

This chart shows the implementation timeframes. The regulations included in Phase 1 must have been implemented by November 28, 2016, regulations included in Phase 2 must have been implemented by November 28, 2017, and regulations included in Phase 3 must have been implemented by November 28, 2019.

On November 22, 2019, the Quality, Safety & Oversight Group at the Centers for Medicare & Medicaid Services (CMS) issued a memo entitled Updates and Initiatives to Ensure Safety and Quality in Nursing Homes that announced a status update on the Interpretive Guidance for: (1) Phase 3 elements of the regulations in Part 483 to Title 42 of the Code of Federal Regulations, the Requirements for States and Long-Term Care Facilities; and (2) skilled nursing facility arbitration agreements under 42 CFR Section 483.70(n). The implementation date for Phase 3 of the Regulations is November 28, 2019. CMS issued the memo to address concerns about the implementation of the Phase 3 requirements and skilled nursing facility surveys after November 28, 2019. CMS announced that it will release updated Interpretive Guidance for Phase 3 of the Regulations in the second quarter of 2020. At that time, CMS will also release information on training and implementing related changes to the Long-Term Care Survey Process.

Ombudsman References in Federal Nursing Home Requirementsside-by-side chart includes references to the Ombudsman Program comparing the revised regulations and related language from the preamble to the current regulations. 

This summary sheet created by Consumer Voice is designed to provide an overview of key changes in the revised federal nursing home regulations that went into effect on November 28, 2019 as part of Phase 3. The purpose of the summary is to highlight what is different (new or modified) between the prior rule and the final rule.

Watch the Consumer Voice's webinar, A Deeper Dive into the Revised Federal Nursing Home Regulations: Part 3. You will hear experts from Center for Medicare Advocacy, Justice in Aging, and Consumer Voice discuss key changes in: (1) Bedholds, and Return to the Facility, (2) Grievances, (3) Resident/Family Councils, and (4) Quality of Care. Download the webinar PowerPoint.

Additional resources on the Federal Nursing Home Regulations are available on the Consumer Voice website and NORC website.

Read archived issues of NORC Notes. If you have a question, are not able to find a resource, or want to share training materials or program practices, please email

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