The regulation, and how many of it we hold
The rulebook is 42 CFR Part 483, Subpart B — Requirements for Long Term Care Facilities. Fifteen of its requirements attach to an individual resident and carry a date. Those fifteen are what ComplyWell runs.
Each one was read from two independent primary sources — the eCFR current text and the GovInfo annual CFR edition — and where the two disagreed the disagreement was resolved against the GovInfo XML, which carries paragraph designators structurally rather than as rendered text. That mattered once: the eCFR rendering flattens the nesting under 483.21(a)(1) so that the baseline care plan content items read as (i) to (vi), when in fact (a)(1)(i) is the 48-hour deadline and the content items are (A) to (F) beneath (a)(1)(ii). Our two rules cite it correctly.
Every requirement we watch for a skilled nursing facility
| The requirement, in plain English | What the clock actually is | Citation |
|---|---|---|
| Comprehensive assessment finished within 14 days of admission | 14 calendar days after admission, excluding readmissions where there was no significant change in condition. | 42 CFR 483.20(b)(2)(i) |
| Comprehensive assessment done after a significant change in condition | 14 calendar days after the facility determines, or should have determined, that a significant change occurred. | 42 CFR 483.20(b)(2)(ii) |
| Comprehensive assessment repeated at least once a year | Not less often than once every 12 months, taken as 365 days — on top of the quarterly reviews. | 42 CFR 483.20(b)(2)(iii) |
| Quarterly review assessment done every 3 months | Not less frequently than once every 3 months, taken here as 92 days — the widest honest reading of the regulation's own words. | 42 CFR 483.20(c) |
| MDS encoded within 7 days of the assessment | 7 days from completion. A separate deadline from transmission, and missed far more often. | 42 CFR 483.20(f)(1) |
| MDS transmitted to CMS within 14 days of the assessment | 14 days from completion, transmitted electronically to the CMS system. | 42 CFR 483.20(f)(3) |
| Baseline care plan in place within 48 hours of admission | 48 hours, counted as 2 calendar days. It covers the first two weeks, long before the comprehensive assessment is finished. | 42 CFR 483.21(a)(1)(i) |
| Baseline care plan carries every required element | No clock — a content check. Initial goals from the admission orders, physician orders, dietary orders, therapy services and social services. | 42 CFR 483.21(a)(1)(ii) |
| Comprehensive care plan written within 7 days of the assessment | 7 days after the comprehensive assessment is completed, and revised after each later assessment. | 42 CFR 483.21(b)(2)(i) |
| Discharge summary carries every required element | No clock — the regulation sets none, so we check the elements rather than invent one. Recapitulation of the stay, final status summary, medication reconciliation, post-discharge plan of care. | 42 CFR 483.21(c)(2) |
| First physician visit inside the first 30 days | Due by day 30. The regulation treats a visit as timely up to 10 days late, so we do not call it red until day 40. | 42 CFR 483.30(c)(1)-(2) |
| Physician visits keeping to the 60-day outer limit | 60 days, timely through 70 under the same 10-day allowance. | 42 CFR 483.30(c)(1)-(2) |
| Pharmacist drug regimen review every month | At least once a month by a licensed pharmacist, taken as 31 days so a same-date monthly rhythm is never called late. | 42 CFR 483.45(c)(1) |
| PRN psychotropic orders not running past 14 days | 14 days from the date the PRN order was written. | 42 CFR 483.45(e)(4) |
| Influenza immunization offered every season | Once each season, October 1 through March 31. We watch the gap since the last record, so read this one as a prompt rather than a verdict. | 42 CFR 483.80(d)(1)(ii) |
Why these are the ones that get missed
Encoding is a different deadline from transmitting, and it is the one that slips
Encoding is the step between finishing the assessment and being able to send it, and the regulation gives 7 days for it. Transmission gets 14. Most facilities track the second and assume the first takes care of itself. Late transmission is also the easiest finding in the whole regulation to prove, because CMS can see it without anyone visiting the building.
483.20(f)(1) and 483.20(f)(3)The 48-hour baseline care plan is an early-survey favorite
Every resident needs one within 48 hours of walking through the door — long before the comprehensive assessment is anywhere near finished. A missing one is a common finding precisely because it lands in the two days when the admission is busiest and nobody is thinking about care planning yet.
483.21(a)(1)(i)A care plan still dated before the most recent assessment
That is the shape a surveyor looks for, and it is not the same question as whether a care plan exists. The comprehensive care plan has to be developed within 7 days of the assessment and revised after each later one, so a plan whose date sits behind the newest assessment tells the whole story on its own.
483.21(b)(2)(i)Standing PRN psychotropic orders that quietly outlive the 14-day limit
A PRN order for a psychotropic drug is limited to 14 days; beyond that the prescriber has to document a rationale and a duration, and for anti-psychotics has to re-evaluate the resident first. That last part matters, because an anti-psychotic PRN cannot simply be re-documented after the fact — it needs a fresh evaluation.
483.45(e)(4) and 483.45(e)(5)Long-stay residents drift past the anniversary quietly
The annual comprehensive assessment goes missing for the same reason everywhere: nothing about the resident's care changed to prompt it. The quarterly reviews happen because they are on a rhythm. The yearly one has no rhythm to ride on.
483.20(b)(2)(iii)What a finding costs
42 CFR 488.438 prints its penalty ranges in 1987 dollars and then says they are “adjusted annually under 45 CFR part 102.” The adjusted amounts are the ones you would actually pay, and they are roughly three times what the regulation text says:
| 42 CFR 488.438 | What the regulation text says | 2025 adjusted amount |
|---|---|---|
| (a)(1)(i) — per day, immediate jeopardy | $3,050 – $10,000 | $8,351 – $27,378 |
| (a)(1)(ii) — per day, lower range | $50 – $3,000 | $136 – $8,211 |
| (a)(2) — per instance | $1,000 – $10,000 | $2,739 – $27,378 |
Per day means the clock keeps running while you fix it. A deficiency found on survey day and corrected three weeks later is priced for all twenty-one of those days. That is the whole argument for finding it on day one.
Source: CMS, LTC-HHA-Hospice-CLIA Calculations of CMP Adjustments — 2025, which applies the 1.03241 cost-of-living multiplier to the 2024 amounts. These are the most recent adjusted amounts CMS has published; there is no 2026 sheet as at 26 August 2026. CMS adjusts annually under 45 CFR part 102, so re-check the figure before quoting it.
Nine of these fifteen rules are not on anyone's schedule.
Six of our fifteen rules sit in 483.20, the assessment schedule. The other nine do not. The 48-hour baseline care plan and its content, the 7-day comprehensive care plan, the discharge summary elements, the two physician visit intervals, the monthly pharmacist drug regimen review, the PRN psychotropic two weeks and the influenza record all live in 483.21, 483.30, 483.45 and 483.80. They are a different set of clocks, owned by different people.
We read an export. We do not need to be your EMR, replace it, or integrate with it — which means the same fifteen rules run whether your building is on one system or on two that do not speak to each other.
What ComplyWell does about it
- You send a resident roster. Usually a scheduled export from the system you already run, emailed to us on a recurring basis. That is a setting inside your own software — no integration, no vendor call, and nobody outside your facility gets access to it.
- The engine counts. Every morning, all fifteen rules run against every resident. It is deterministic date arithmetic against dates from your own records — a subtraction, not a prediction. It cannot invent a deadline the regulation does not create.
- One brief goes to the named person. A short email to the administrator, Director of Nursing or MDS coordinator you nominate, each finding sorted into Action due or Past due, and an All clear when there is nothing open.
- Every finding carries its evidence. For example: the first physician visit happened on day 51 after admission; it was due by day 30 and timely only through day 40, so it was 11 days late — followed by the admission date, the visit date and the day counts that produced it, straight from your own export.
- Every brief is dated. The top of the brief names the export it was built from, so you always know exactly how current the numbers are.
Get Your Free Compliance Check
Send us one roster export. We will run all fifteen Part 483 rules against your own dates and show you exactly what is open today, with the citation and the evidence behind each one — including the nine that sit outside the assessment schedule.
Get Your Free Compliance Check