CMS Conditions of Participation (CoPs) for Healthcare Providers
Last reviewed · By Chad Griffith
Conditions of Participation (CoPs) are the federal health and safety standards that healthcare facilities must meet to participate in Medicare and Medicaid. CoPs are codified at 42 CFR with separate Parts for each provider type: hospitals (Part 482), long-term care facilities (Part 483), home health agencies (Part 484), hospices (Part 418), ambulatory surgical centers (Part 416), and others. Deficiencies cited during state surveys are documented on Form CMS-2567 with F-Tag identifiers, scope and severity ratings, and required corrective action plans. Repeated deficiencies above defined thresholds can trigger Medicare termination — the most serious enforcement outcome short of criminal action against individual practitioners.
Hospital CoPs (42 CFR Part 482)
Hospital CoPs at 42 CFR 482 cover: governing body (Section 482.12), patient rights (482.13), QAPI (482.21), medical staff (482.22), nursing services (482.23), medical record services (482.24), pharmaceutical services (482.25), radiologic services (482.26), laboratory services (482.27), food and dietetic services (482.28), utilization review (482.30), discharge planning (482.43), and infection prevention and antibiotic stewardship (482.42). Hospitals participating in Medicare must meet all applicable CoPs at all times. Specialty hospitals (long-term care hospitals, psychiatric hospitals, rehabilitation hospitals) have additional CoPs in subsequent subparts.
The 482.13 patient rights condition has been one of the most-cited areas in recent years, particularly around use of restraints and seclusion (subsection 482.13(e)-(h)) which require physician order, monitoring, restraint of last resort criteria, and specific documentation. Restraint and seclusion deficiencies frequently cite multiple subsections producing compounding citations.
Long-Term Care CoPs (42 CFR Part 483)
Skilled nursing facilities and nursing homes operate under 42 CFR Part 483. Subpart B contains the long-term care facility requirements covering: resident rights (Section 483.10), freedom from abuse, neglect, and exploitation (483.12), admission and discharge (483.15), resident assessment (483.20), comprehensive care planning (483.21), quality of life (483.24), quality of care (483.25), physician services (483.30), nursing services (483.35), behavioral health services (483.40), pharmacy services (483.45), laboratory radiology and other diagnostic services (483.50), dental services (483.55), nutrition (483.60), specialized rehabilitation services (483.65), administration (483.70), QAPI (483.75), infection control (483.80), compliance and ethics (483.85), physical environment (483.90), training requirements (483.95), and Medicaid-specific requirements (Subpart C).
The Reform of Requirements for Long-Term Care Facilities final rule (October 2016, phased implementation through November 2019) substantially expanded SNF CoPs. F-Tag F689 (Free of Accident Hazards / Adequate Supervision) and F684 (Quality of Care) are consistently among the top-five most-cited tags in CMS Care Compare data.
Home Health CoPs (42 CFR Part 484)
Home health agencies operate under 42 CFR Part 484, with the current rule effective January 13, 2018. Conditions cover: patient rights (Section 484.50), notice of rights (484.50(a)), exercise of rights (484.50(b)), rights of patient (484.50(c)), patient liability for payment (484.50(d)), home health aide services (484.80), administration (484.105), clinical records (484.110), QAPI (484.65), infection prevention and control (484.70), care planning, coordination, and quality of care (484.60), conditions of operation (484.100, 484.115), and compliance (484.120).
Notable HHA CoP requirements include the Comprehensive Patient Assessment (484.55) which must be completed within 5 calendar days of the start of care, the Plan of Care (484.60) which must be established and periodically reviewed by the patient's physician, and Infection Prevention and Control (484.70) which requires a coordinated infection prevention program addressing employee health and safety, vaccinations, and surveillance.
Hospice CoPs (42 CFR Part 418)
Hospices operate under 42 CFR Part 418. Conditions cover: patient rights (Section 418.52), comprehensive assessment of the patient (418.54), interdisciplinary group (IDG, 418.56), plan of care (418.56(d)), specialized services (418.60-66 covering nursing, medical social services, counseling, hospice aide services, volunteers), drugs and biologicals (418.106), short-term inpatient care (418.108), continuous home care (418.110), inpatient respite care (418.108(b)), QAPI (418.58), infection control (418.60), and license and certification of personnel (418.114).
The four levels of hospice care defined in 418.108 (routine home care, continuous home care, general inpatient care, inpatient respite care) each have specific eligibility criteria, documentation requirements, and reimbursement rates. Inappropriate level-of-care billing is a frequent area of CMS audits and OIG investigations under the False Claims Act.
Survey Process and Form CMS-2567
State Survey Agencies (SSAs) under contract with CMS conduct surveys to verify CoP compliance. Surveys are typically unannounced (some specific survey types are scheduled). Surveyors document findings on Form CMS-2567 ('Statement of Deficiencies and Plan of Correction') using F-Tag identifiers tied to specific CFR subsections. Each finding includes: F-Tag number, regulatory citation, statement of deficiency, scope (isolated, pattern, widespread), and severity (no actual harm with potential for minimal/more than minimal/actual harm; immediate jeopardy).
Scope and severity combine into a letter grade A through L per CMS State Operations Manual Appendix PP. Letters A, B, C represent no actual harm with potential for minimal harm. Letters D, E, F: pattern or widespread no-actual-harm but more than minimal potential. Letters G, H, I: actual harm. Letters J, K, L: immediate jeopardy. The letter grade drives consequences: civil money penalties (CMPs), denial of payment for new admissions, training requirements, or termination of the provider agreement.
Plan of Correction (PoC) and Timeline
Following survey, providers must submit a Plan of Correction (PoC) addressing each deficiency cited on the CMS-2567. The PoC must specify: corrective action for the cited issue, how the corrective action will prevent recurrence, monitoring procedures to ensure sustained compliance, and the projected completion date for each element. PoC submissions are due within 10 calendar days of receipt of the CMS-2567.
The corrective action timeline depends on severity. Immediate jeopardy citations require immediate removal — corrected before survey exit or face termination of provider agreement. Substandard quality of care typically must be corrected within 23 days. Other deficiencies typically have a 60-day correction window. Civil money penalties may accrue per day until correction is verified during a follow-up revisit by SSA surveyors.
Frequently Asked Questions
What is the difference between a CoP and a CfC?
Both are CMS-issued health and safety standards. Conditions of Participation (CoPs) apply to most institutional providers (hospitals, SNFs, HHAs, hospices, ASCs). Conditions for Coverage (CfCs) apply to suppliers and certain entities (e.g., ESRD facilities, organ procurement organizations, IDTFs). The standards differ but the survey and enforcement process is similar.
What is deemed status?
Deemed status is the recognition that an accredited healthcare organization has met the equivalent of CMS Conditions of Participation through accreditation by a CMS-approved accrediting organization (Joint Commission, DNV, HFAP, AAAHC, ACHC, CIHQ, etc.). Deemed-status organizations are not subject to routine state surveys for CMS-mandated CoP compliance, though state surveyors still conduct complaint surveys and Life Safety Code surveys regardless of accreditation status.
What is the most serious survey outcome?
Termination of the Medicare provider agreement is the most serious enforcement action. Termination removes the provider's ability to bill Medicare and Medicaid, effectively closing many facilities. CMS uses termination only after sustained non-compliance and failure to correct, typically with civil money penalties accruing throughout the process. Immediate jeopardy citations can lead to expedited termination if not removed within 23 days.
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