HUD Begins Scoring NSPIRE Affirmative Requirements. On September 29, the Department of Housing and Urban Development (HUD) published a notice seeking public input on changes to the way housing inspections are scored at HUD-assisted properties. Titled “National Standards for the Physical Inspection of Real Estate,” the notice makes three revisions to the NSPIRE Scoring Notice for public comment, including to initiate scoring for newly inspected standards beginning October 1, as well as two minor technical corrections to previously published methodologies related to determining sample size for inspections. The NSPIRE Scoring Notice does not apply to the Housing Choice Voucher and Project-Based Voucher programs and does not revise the inspection frequencies established under the applicable program regulations. Comments are due to HUD by November 30, and LeadingAge will work with our membership to submit our feedback. For example, LeadingAge previously worked with HUD to delay scoring for the affirmative standards and applauds HUD for providing a grace period for providers, who were still required to fix any deficiencies that were not scored; however, the agency published the notice to end the grace period in certain scoring just a day prior to the change taking effect; LeadingAge calls on HUD to provide more timely information in the future. Here is your weekly Affordable Housing Weekly Recap.
CMMI GUIDE staff will also be joining the October 22 LeadingAge Adult Day Network at 1 p.m. ET to discuss the opportunities for adult day providers in the model and to answer members’ questions about the model. If you are interested in joining this discussion, reach out to Georgia Goodman at ggoodman@leadingage.org for details on how to join. Also, stay tuned for more details for GUIDE participants and providers to participate in a November discussion with CMMI GUIDE staff on the Residential Care Community changes and challenges, and how to meet the needs for respite care under the model.
DHS proposes a $70,000 fee on student workers DHS today released a proposed rule that would charge schools $70,000 before recommending international students on an F-1 visa for Optional Practical Training (OPT), and $30,000 for each later OPT period. OPT allows foreign students to work during and after a course of study. DHS cites fraud and the protection of U.S. workers and says it may shut down OPT entirely without the fees. Schools could pass the cost on to students or employers. For aging services, the concern is international graduates of U.S. nursing and allied health programs who use OPT to move into their first U.S. jobs. The rule is scheduled for Federal Register publication on October 8, with comments due 30 days later. A full analysis with recommended next steps for members is coming soon. Bill to Help Immigrants Enter Health Care Careers Reintroduced On October 2, Representatives Adam Smith (D-WA) and Raja Krishnamoorthi (D-IL) announced the reintroduction of the Immigrants in Nursing and Allied Health Act, a bill to help work-authorized immigrants overcome barriers to entering nursing and allied health professions in the United States. The bill would establish a grant program through the Department of Health and Human Services (HHS) to support education, training, licensure, certification, English-language instruction, and other workforce integration activities for immigrants pursuing healthcare careers. The legislation aims to address the notion that many immigrants already living and working in the United States possess valuable skills and experience that are not fully utilized because of training, credentialing, financial, or other workforce-entry barriers. The bill complements another proposal introduced earlier this year by the same cosponsors, the Welcome Back to the Health Care Workforce Act , which would create a grant program to help internationally educated healthcare professionals navigate credentialing, licensing, and workforce integration challenges. While the Welcome Back bill focuses primarily on individuals who already possess healthcare education and training from another country, the Immigrants in Nursing and Allied Health Act takes a broader approach by supporting immigrants seeking to enter nursing and allied health professions, regardless of previous education and training. For LeadingAge members, both bills are noteworthy because they seek to unlock talent that is already present in the United States rather than creating new immigration pathways. LeadingAge supports the Immigrants in Nursing and Allied Health Act as part of its broader workforce policy agenda. Alongside efforts to modernize training and credentialing systems, expand apprenticeship and career pathway opportunities, and improve legal immigration pathways, the legislation represents another approach to growing the aging services workforce and helping providers address persistent staffing shortages. Here is your weekly Workforce Weekly Recap
CDC Releases Updated Return-to-Work Guidance. The Centers for Disease Control & Prevention (CDC) has released updated guidance outlining recommendations for work restriction for healthcare personnel related to respiratory viruses. LeadingAge has vigorously advocated for such guidance for years. The guidance replaces the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 previously used for work restrictions for healthcare personnel exposed to or infected with COVID-19. The new guidance is based on recommendations from CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), approved during the Committee’s last meeting in November 2024 before it was disbanded in March 2025. The new guidance applies to respiratory illnesses “not addressed elsewhere” in CDC guidance, including flu, respiratory syncytial virus (RSV), and COVID-19. According to this guidance, asymptomatic healthcare personnel who have been exposed to a respiratory illness do not need to be restricted from work but should wear source control from the day of first exposure through at least the fifth day after exposure. Healthcare personnel with a suspected or confirmed viral respiratory infection should be restricted from work until all four conditions are met: At least three days have passed since symptom onset (or first positive test, for asymptomatic infections), The individual is fever-free for at least 24 hours without the use of fever-reducing medications, Symptoms are improving, and The individual feels well enough to return to work. Testing to determine the specific respiratory illness is not required; however, CDC recommends following guidance specific to the respiratory pathogen should the individual opt for testing. LeadingAge is very pleased to see this updated guidance after years of advocacy and urges CDC to similarly update transmission-based precautions for healthcare settings and retire outdated guidance for SARS-CoV-2 infections among patients in healthcare settings, including residents in nursing homes. Infection Control Guidance: Measles. With measles cases being reported across the U.S., LeadingAge members should be prepared to identify and address this highly contagious illness. Stay on top of case prevalence in your local area and coordinate with your local public health for guidance. The Centers for Disease Control & Prevention (CDC) also has resources available to help. Check out Healthcare Providers: Stay Alert for Measles and Measles Preparedness and Response in Healthcare Settings to get started.
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Special Edition Nursing Home Network, October 15 at 3pm ET. The Nursing Home Network will meet for a special call on Thursday, October 15 at 3pm ET. The purpose of this call will be to review and provide input on the nursing homes section of the LeadingAge Policy Platform. Please note that this call will not replace the regularly scheduled monthly Nursing Home Network call, scheduled for Tuesday, October 27. Members of the Nursing Home Network will receive the login for the October 15 call by email. Not yet a member of the Nursing Home Network? Register here using your LeadingAge login. New National Shared Credentialing Process for Health Plans Begins Nov. 1. United Healthcare, Cigna and Centene will begin using a shared portal for their contracted providers to submit their credentialing information. For providers participating in these plans and others who join, this means they will submit their credentialing information once instead of once per plan. For more information about the new process, what it means for providers and what to do next, check out the LeadingAge article here . New HUB Resource for Hospice Care in Nursing Homes. LeadingAge is incredibly excited to share our new resource to help providers better coordinate care for nursing home residents receiving hospice services, Hospice Care in Nursing Homes: A Shared Responsibility. The education resource reviews five sections, relationship and communication processes, regulation and reimbursement including regulatory co-management expectations, navigating complex scenarios, care coordination, and tools for building contracts, which were developed from a series of listening sessions with both hospice and nursing home members. MA Disenrollment of SNF Residents in the Spotlight. The Center for Medicare Advocacy reports that nursing homes are disenrolling residents from their Medicare Advantage plans without their knowledge and that the Centers for Medicare and Medicaid Services (CMS) have long-standing guidance that reinforces that these changes should only be initiated by the beneficiary or their authorized representatives. LeadingAge reminds members that such disenrollment actions by nursing homes can result in survey tags and investigations for fraud and abuse, while also can have wide-ranging implications for the beneficiaries. More details can be found in this LeadingAge article including links to the two CMS memos that outline what is permitted and the required steps that must be taken if nursing homes opt to assist beneficiaries and families with these decisions. CMS Updates HAI Measure to Include Claims Data. The Centers for Medicare & Medicaid Services (CMS) released an update to the Skilled Nursing Facilities (SNF) Quality Reporting Program (QRP) measure technical specifications on September 24, re-specifying the Healthcare-Associated Infections (HAI) Requiring Hospitalization measure. This measure will now include Medicare Advantage (MA) encounter data in addition to the Medicare Fee-for-Service data that was already included in calculations. The measure specifications also include updates to risk adjustment based on the inclusion of this data. Read the updated specifications in the technical specification report, available in the Downloads section of the SNF QRP Measures and Technical Information page. Transparency Win: CMS Directs MACs to Publish Quarterly Data on TPE. In a Change Request (CR 14616) published on September 30, 2026, the Centers for Medicare and Medicaid Services (CMS) directs Medicare Administrative Contractors (MACs) to post Target Probe and Educate (TPE) results quarterly on their websites. This is a big win for home health, hospice, and nursing home providers who, until now, had no insights into trends and issues concerning TPE. LeadingAge has repeatedly called for this kind of transparency from MACs, most recently in our response to the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) Request for Information. The changes CMS is requiring will take effect November 2, 2026. CMS states that, at a minimum, MACs must post the three most common reasons per Targeted Probe and Educate prioritized problem on their websites. Additionally, if more than three denial reasons for a specific topic would be useful, the MACs should include those as well. This information will go a long way towards educating the greater provider community regarding what payment processing issues and trends.
HUD Report Highlights BABA Implementation, Monitoring Issues. On September 10, the Department of Housing and Urban Development (HUD) published a report by its own oversight entity, the Office of the Inspector General (OIG), evaluating the agency’s implementation of Build America, Buy America (BABA) requirements throughout HUD programs. The Buy America Preference within BABA requires federal agencies to limit federal infrastructure spending unless the iron, steel, manufactured, and construction products used were domestically sourced in the U.S., which has proven infeasible for LeadingAge members developing new affordable housing units. The report, titled “HUD Needs to Improve its Monitoring of the Buy America Preference of the Build America, Buy America Act,” called out HUD’s lack of compliance monitoring for BABA; OIG recommends that HUD designate an official responsible for overseeing BABA implementation and consistency across HUD program offices. BABA is applicable to four HUD program offices, including the Office of Multifamily Housing Programs, which administers the Section 202 Supportive Housing for the Elderly program, as well as the Green and Resilient Retrofit Program (GRRP), both of which are subject to BABA requirements. LeadingAge continues to urge HUD and Congress to fully exempt affordable housing developments from the Buy America requirements because they are too difficult to execute and the original statute did not intend to BABA requirements to affordable housing. HUD Publishes LeadingAge-Driven Flexibilities on Emergency Call Systems. On September 10, the Department of Housing and Urban Development (HUD) published new guidance, driven by concerns shared by LeadingAge, to create more flexibility within emergency notifications system requirements for affordable senior housing providers. Previously, the agency required owners of certain HUD-assisted senior housing communities to operate emergency call systems in independent living units, which could be used by residents to call for aid in the case of an emergency, like a fall or a medical event. However, LeadingAge members consistently reported issues with the call systems, including residents misusing the systems and property insurance providers limiting whole-building coverage because of the perceived liability risk associated with the medical nature of the emergency notification devices and systems. Further, many residents reported to housing providers that they prefer to utilize personally-worn emergency devices and view the property call system as overreach by housing providers. In its new guidance, HUD makes the systems optional and encourages owners to conduct wellness checks instead, which many LeadingAge affordable housing providers already do. LeadingAge confirmed with HUD that the removal of the now optional emergency notification systems is a project-eligible expense. We applaud HUD for addressing the concerns of senior housing communities, and we will work with our membership to ensure the highest quality of housing for HUD-assisted residents. Here is your weekly Affordable Housing Weekly Recap.
LeadingAge and Hospice Advocates Meet with OMB and DEA on Final Teleprescribing Rule
Federal District Court Vacates Multiple Provisions of HHS' Section 504 Rule Relating to the Integration Mandate
