F646: Notify the appropriate authorities when residents with MD or ID services has a significant change in condition
F646 is one of the federal requirements every Medicare and Medicaid certified nursing home must meet. CMS describes it as: Notify the appropriate authorities when residents with MD or ID services has a significant change in condition.
It sits in CMS's resident assessment and care planning 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). 12.6% of F646 citations came from a complaint visit rather than a routine inspection.
By letter: B 5, D 221, E 12.
What inspectors wrote
Three recent F646 citations from different states, quoted from the inspectors' statements of deficiencies (CMS form 2567). Names are removed by CMS.
Inspectors wrote, July 23, 2026, scope and severity DBased on interview, record review and facility policy review, the facility failed to notify the State Mental Health Authority of a significant change in status for one resident (Resident (R)1) in a total sample of eight who was previously identified as having a serious mental illness.
Prairie Maison, Prairie Du Chien, WI
Inspectors wrote, July 16, 2026, scope and severity DBased on record review, and staff interview, the facility failed to notify the state mental health authority with a significant change pre-admission screening and resident review (PASARR) for residents with a change in their mental health or physical conditions. This affected two (#2 and #37) of four residents reviewed for significant change PASARR. The facility census was 45.
Cedars of Lebanon Care Center, Lebanon, OH
Inspectors wrote, June 26, 2026, scope and severity DBased on record review and staff interviews, the facility failed to submit a request for a Level II Preadmission Screening and Resident Review (PASRR) reevaluation after a significant change in physical or mental status was identified for a resident previously determined to have a Level II PASRR. This deficient practice affected 1 of 2 sampled residents reviewed for PASRR (Resident #90).
Smoky Ridge Health and Rehabilitation, Burnsville, NC
Most recent F646 citations
F646 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.
By inspection year: 2018 1, 2019 6, 2020 1, 2021 6, 2022 22, 2023 38, 2024 57, 2025 71, 2026 36.
Common questions
- What is F646 in a nursing home inspection?
- F646 is the federal requirement to "notify the appropriate authorities when residents with md or id services has a significant change in condition". CMS files it under resident assessment and care planning. A home cited under F646 did not meet that requirement at the inspection.
- How often is F646 cited?
- The CMS files as of September 1, 2026 list 238 F646 citations at 230 nursing homes, 55 of them in the 12 months to that date. 0.0% were rated as actual harm or immediate jeopardy.
- Is a F646 citation serious?
- It depends on the letter. Most F646 citations (97.9%) 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