CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 8 — Coverage of Extended Care (SNF) Services Under Hospital Insurance. Skilled coverage, the daily-basis and practical-matter tests, and the covered-services list.
CMS Medicare Program Integrity Manual (Pub. 100-08) — medical review / ADR standards applied to Part A SNF review.
42 CFR Part 483 — Requirements for Long-Term Care Facilities, with the State Operations Manual Appendix PP interpretive guidance and F-tags (F580 notification; F636–F657 assessment and care planning; F684 quality of care; F697 pain; F758 unnecessary drugs).
CMS MDS 3.0 RAI User’s Manual, v1.20.1, effective October 1, 2025 — the RAI process, MDS sections, and the supportive-documentation expectation.
SNF PPS / PDPM — the Part A case-mix model; verify the current fiscal-year SNF PPS final rule at time of use.
Jimmo v. Sebelius — the maintenance-coverage standard: skilled coverage does not require improvement.
Standing flags. Worked examples are scaffolds — fill them with the shift’s actual values and confirm every threshold against current orders. Coverage amounts, staffing rules, and qualifying-stay waivers change; verify each against the current published source. MAC/LCD and accreditation (TJC/CHAP LTC) items are facility-fill.
