This letter from CMS outlines the requirements for physician services in nursing homes or other healthcare facilities. It states that a physician must personally approve in writing a recommendation for admission to the facility, and that each resident must remain under the care of a physician. The letter also outlines the need for a physician to supervise the medical care of each resident, and for another physician to take over when the attending physician is unavailable. It provides definitions of attending physician, non-physician practitioner, nurse practitioner, clinical nurse specialist, and physician assistant. It also provides guidance on the written recommendation for admission, supervision of medical care, availability of other physicians when the attending physician is unavailable, and probes and potential tags for additional investigation. This letter will impact nursing homes and healthcare facilities by requiring them to ensure that each resident has a physician who is able to provide orders for the resident's immediate care and needs, and that the resident's medical care is supervised by a physician. Facilities must also contact another physician when the attending physician is unavailable, and must follow up on recommendations from dietitians and other healthcare professionals. They must also be aware of the probes and potential tags for additional investigation outlined in the letter.

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