CMS State Operations Manual Appendix A — Hospital Survey Protocol

Citation

CMS State Operations Manual, Publication 100-07, Appendix A — Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Rev. 238, Issued March 20, 2026. 613 pages.

What It Says (Verbatim, Where Pest-Relevant)

Definitive finding: The current CMS State Operations Manual Appendix A contains no pest-related interpretive guidance. A full-document text extraction of Rev. 238 (27,201 lines, ~1.48 million characters, May 25, 2026) followed by exhaustive case-insensitive search returns zero matches for the following terms across the entire document: “pest,” “vermin,” “rodent,” “insect,” “infestation,” “roach,” “cockroach,” “rat,” “mice,” “mouse,” or “integrated pest.” A second, independent extraction of the same PDF (MD5 cf26c249b3c544aaecf7e130bfc1a1d6; ~1.52 million characters) on September 11, 2026 measured the same result, whole-word and substring: pest 0, vermin 0, rodent 0, insect 0, infestation 0, “integrated pest” 0; for comparison, “sanitary” 6 and “housekeeping” 9.

The closest environment-sanitation language is the tag for §482.42(a)(3), A-0750, whose heading is the regulation text itself and whose Interpretive Guidelines open, verbatim:

“The hospital must provide and maintain a clean and sanitary environment to avoid sources and transmission of infections and communicable diseases. All areas of the hospital must be clean and sanitary. This includes all hospital departments and off-site locations. The infection prevention and control program should include appropriate monitoring of housekeeping, maintenance (including repair, renovation and construction activities), and other activities to ensure that the hospital maintains a sanitary environment. Examples of areas to monitor would include the hospital’s: onsite laundry facilities, food storage, preparation, serving and dish rooms, refrigerators, ice machines, air handlers, autoclave rooms, venting systems, inpatient rooms, treatment areas, labs, waste handling, surgical areas, supply storage, equipment cleaning, etc.”

Five of the manual’s six occurrences of “sanitary” are in that tag’s regulation text, guidance, and survey procedures; the sixth is a passing reference to “sanitary food preparation” elsewhere. The dietary condition, §482.28 (tag A-0618), expects written policies covering “Guidelines for kitchen sanitation.” Pest control is not named anywhere.

Correction to this page’s earlier text. Until September 11, 2026 this page quoted, as the A-0750 language, a sentence beginning “The hospital must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active program for the prevention, control, and investigation of infections…” That sentence does not occur in Rev. 238; it tracks the pre-2019 text of §482.42. The passage above is what the current manual says. The same correction was made on the A-0747, A-0750, and A-0758 pages.

What It Means in Plain Language

Appendix A is the operational manual surveyors use when conducting CMS validation surveys of hospitals. It contains interpretive guidance, A-tag definitions, and survey procedures for every Condition of Participation in 42 CFR Part 482. If CMS wanted surveyors to evaluate pest control as a specific compliance domain, the guidance would appear here.

It does not appear here. CMS has no pest-specific interpretive guidance for hospital surveyors in its current operational manual.

This finding materially changes the federal regulatory landscape for hospital pest control. The regulatory framework operates almost entirely by inference. Surveyors evaluating pest activity work from the umbrella “safety and well-being” language in §482.41(a) and from the “sanitary environment” language in §482.42 — both of which are general environmental quality requirements, not pest-specific mandates.

Who It Applies To

All CMS-participating hospitals during validation surveys conducted by State Survey Agencies. Deemed-status hospitals (those accredited by The Joint Commission, DNV-GL, HFAP, or CIHQ) are typically surveyed only by complaint investigation rather than routine survey.

Documentation Evidence Required

Not applicable — the manual specifies no pest-management documentation requirements.

How Surveyors Evaluate Pest Activity in the Absence of Guidance

Surveyors observing pest activity during a CMS validation survey cite the activity to the most directly applicable A-tag. In practice this means:

• Pest activity in patient-care areas, food service, or environmental services spaces is most commonly cited under A-0701 (§482.41(a) Standard: Buildings) as a failure of the physical environment safety standard
• Pest activity in food preparation and supply areas may be cited under A-0722 (§482.41(d) Standard: Facilities) or its sub-tag A-0724 (§482.41(d)(2)), whose guidance requires that “the condition of the physical plant and overall hospital environment is developed and maintained in a manner that provides an acceptable level of safety and well-being of patients, staff and visitors”
• Pest activity framed as an infection control failure is written at A-0750 (§482.42(a)(3), clean and sanitary environment) and may be cross-referenced to the condition at A-0747 (§482.42); A-0749 (§482.42(a)(2), methods for preventing and controlling transmission) names no area of the hospital and is a far less likely home for a pest finding

Every tag heading above was read from the full text of Rev. 238 on September 11, 2026, and agrees with the operator’s grep of the same PDF on September 10, 2026. The same reading confirmed that tag A-0758, which circulates in some pest-control materials, does not exist: the sequence runs A-0750, A-0751, A-0760, and A-0752 through A-0759 are absent. See A-0758 does not appear in Appendix A.

Severity escalation to condition-level deficiency is uncommon but documented in cases of active rodent infestation in dietary or sterile-processing areas.

If You Are Responding to a Survey Finding

Most readers arrive at this page holding a Form CMS-2567. The tag on the form tells you which page to read next. Every tag below was verified against the full text of Rev. 238 on September 11, 2026; each page quotes its heading, regulation text, Interpretive Guidelines, and Survey Procedures verbatim. If you do not yet know which regime’s tag applies to your facility, start at Which tag is pest control?.

• A-0701 — Standard: Buildings (§482.41(a)): the tag most pest observations in patient-care and support areas are written to.
• A-0750 — Clean and Sanitary Environment (§482.42(a)(3)): the tag that carries the manual’s sanitary-environment language and its list of areas to monitor; where a pest finding framed as infection control is most likely written.
• A-0700 — Condition: Physical Environment (§482.41): the condition-level citation for the physical environment as a whole.
• A-0722 — Standard: Facilities (§482.41(d)), with A-0724 (§482.41(d)(2)): the tags for pest activity in food preparation, supply storage, and other service areas.
• A-0747 — Condition: Infection Prevention and Control and Antibiotic Stewardship Programs (§482.42): the condition-level cross-reference when pest activity is framed as an infection control failure.
• A-0749 — Methods for Preventing and Controlling Transmission (§482.42(a)(2)): the tag whose 2016-era predecessor carried the “Techniques for pest control” bullet, now gone; its current subject carries no pest language.
• A-0758: does not exist in Appendix A. If that number is on your paperwork, start there.

If the hospital is Joint Commission accredited and the same observation appears on the accreditation report, see PE.01.01.01 for pest activity and PE.02.01.01 EP 4 for pesticide storage.

Confidence Notes

HIGH confidence. Full document downloaded and text-extracted via pdfplumber on May 25, 2026: 27,201 lines / approximately 1,481,684 characters extracted across all 613 pages with zero truncation, with exhaustive case-insensitive search for all pest-vocabulary terms. Re-extracted independently (PyMuPDF, ~1.52 million characters) from the reference’s archived copy of the same PDF on September 11, 2026 with identical zero-hit results; the A-0750 quotation, the tag headings, and the A-0751 → A-0760 sequence were read from that extraction.

Related Killed Claims

• “A-0749 contains the bullet ‘Techniques for pest control’ under §482.42(a)(1) interpretive guidelines.” This bullet appeared in the 2016 SOM Appendix A archived at SPICE-UNC. It does not appear in current Rev. 238. CMS removed pest-control interpretive guidance from Appendix A at some point between 2016 and 2026. Any research citing this bullet as current is using a superseded archive.
• “CMS Conditions of Participation include explicit pest control mandates.” Disconfirmed. Neither the regulation (§482.41) nor the interpretive guidance (Appendix A) contains pest-specific mandates. Federal hospital pest regulation operates entirely by inference under umbrella safety and sanitation language.