US · guidance
CMS SOM App. J, Tag W346
§483.460(d)(4) If the facility utilizes only licensed practical or vocational nurses to provide
health services, it must have a formal arrangement with a registered nurse to be available for
verbal or onsite consultation to the licensed practical or vocational nurse.
Guidance §483.460(d)(4)
The facility must have written arrangements with a registered nurse (RN) to provide
consultation in those instances where LPNs/LVNs provide all the direct nursing care for the
clients. Verify that the agreement requires the RN to respond promptly to all calls from the
LPN/LVN and to come on-site to the facility if necessary. The facility must also ensure registered
nurse back-up when the primary registered nurse consultant is unavailable (vacations, etc.).
Review documentation in the client records to confirm that the LPNs/LVNs of the facility are
consulting the registered nurse consultant when indicated and that she/he responds promptly
to such calls.
History
Rev. 135, Issued: 02-27-15, Effective: 04-27-15, Implementation: 04-27-15
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
06944e83381dea1c877073a7d36ea7d1bec291bed34deb352d1892a343dcdeee
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.