F621: Treat residents equally regarding transfer, discharge, and provision of services for all residents, regardless of payment source
F621 is one of the federal requirements every Medicare and Medicaid certified nursing home must meet. CMS describes it as: Treat residents equally regarding transfer, discharge, and provision of services for all residents, regardless of payment source
It sits in CMS's resident rights category.
CMS Health Deficiencies file, data as of September 1, 2026. The files hold each home's last three standard inspections and three years of complaint visits.
How seriously inspectors rate it
Every citation gets a letter for how much harm inspectors found and how many residents it touched (how to read the letters). 62.5% of F621 citations came from a complaint visit rather than a routine inspection.
By letter: D 7, E 1.
What inspectors wrote
Three recent F621 citations from different states, quoted from the inspectors' statements of deficiencies (CMS form 2567). Names are removed by CMS.
Inspectors wrote, January 21, 2026, scope and severity EBased on observation, interview and record review, the facility failed to ensure there was no discrimination against Medicaid funded residents and failed to ensure Medicaid residents were not being discharged because of payment source. These failures caused residents to not have the right to stay in the facility or to be discharged to a facility that they did not want to live in.
Puyallup Post Acute, Puyallup, WA
Inspectors wrote, August 27, 2025, scope and severity DBased on interview and record review, the facility failed to follow the policy and procedure (P&P) titled, Admission, Transfer, Discharge and Bed-Holds, for one of three sampled residents (Resident 1) when Resident 1 (a veteran - someone who has served in a nation's armed forces) was denied admission for rehabilitation services based on payment source. [...]
Pacific Gardens Nursing and Rehabilitation Center, Fresno, CA
Inspectors wrote, August 8, 2025, scope and severity DBased on interview and record review, the facility failed to establish, maintain and implement identical policies and practices regarding transfer and discharge and the provision of services for all individuals regardless of source of payment for 1 (Resident #5) of 4 residents reviewed for equal access to quality care. The facility failed to ensure Resident #5's right to stay in the facility and he was transferred to the hospital because his payor source ended. The failure could place residents at risk of a loss of self-determination and dignity.
The Lev at Winchester, Alvin, TX
Most recent F621 citations
| Inspection | Home | Town | Letter |
|---|---|---|---|
| January 21, 2026 | Puyallup Post Acute | Puyallup, WA | E |
| August 27, 2025 | Pacific Gardens Nursing and Rehabilitation Center | Fresno, CA | D |
| August 8, 2025 | The Lev at Winchester | Alvin, TX | D |
| June 3, 2025 | Cedar Ridge Center | Skowhegan, ME | D |
| March 13, 2025 | Powder River Manor | Broadus, MT | D |
| December 20, 2024 | Armstrong Rehabilitation and Nursing Center | Kittanning, PA | D |
| September 26, 2024 | Brickyard Healthcare - Twelfth Street Care Center | Mishawaka, IN | D |
| February 13, 2024 | Heritage Care Center | Pittsburgh, PA | D |
F621 citations by state
Counts depend on how many homes a state has and how often its inspectors visit, so a larger number is not by itself a worse record.
| State | Citations |
|---|---|
| Pennsylvania | 2 |
| California | 1 |
| Indiana | 1 |
| Maine | 1 |
| Montana | 1 |
| Texas | 1 |
| Washington | 1 |
By inspection year: 2024 3, 2025 4, 2026 1.
Common questions
- What is F621 in a nursing home inspection?
- F621 is the federal requirement to "treat residents equally regarding transfer, discharge, and provision of services for all residents, regardless of payment source". CMS files it under resident rights. A home cited under F621 did not meet that requirement at the inspection.
- How often is F621 cited?
- The CMS files as of September 1, 2026 list 8 F621 citations at 8 nursing homes, 1 of them in the 12 months to that date. 0.0% were rated as actual harm or immediate jeopardy.
- Is a F621 citation serious?
- It depends on the letter. Most F621 citations (100.0%) were rated as potential for more than minimal harm, D to F. None in the current files is at the immediate jeopardy level.
The interpretive guidance inspectors use for each F-tag is CMS's State Operations Manual, Appendix PP. NursingHomeClear reports the citations as CMS records them and is not affiliated with CMS. All F-tags · Methodology