Nursing Home News 2025Dec04
Advocacy WIN! CMS Repeals Nursing Home Minimum Staffing Standards
An interim final rule repealing the nursing home minimum staffing standards was released to the Federal Register on December 2. Read the LeadingAge press release on this interim final rule here. It is important to note that the rule released on December 2 does not repeal the entire rule that was finalized in May 2024. The interim final rule repeals only the staffing standards portion of the May 2024 rule. Requirements for enhanced Facility Assessment and Medicaid payment transparency reporting remain in effect. The December 2 rule includes a comment period for soliciting public feedback, ending in early February. It is likely that we will see a rule proposed in the future that addresses nursing home staffing in some way; CMS will use comments received on this interim final rule to guide future rulemaking. For more information on this interim final rule and the life of the minimum staffing standards, check out the LeadingAge serial post.
CMS Releases New Resources Following CMPRP Revisions
Following the September 29 revisions to the Civil Money Penalties Reinvestment Program (CMPRP), the Centers for Medicare & Medicaid Services (CMS) released several new resources to assist providers in applying for CMPRP funding. Resources are available in the “Downloads” section on the CMS webpage and include a new standardized application and budget attachment; a comprehensive application handbook that includes information on allowable expenses, tips on completing applications, and a sample project application; a Frequently Asked Questions document; and a new resource that discloses available CMPRP funds by state. While LeadingAge had hoped program revisions would include expansions to allow program funds to be used for telemedicine supplies, we are pleased that project expansions include behavioral health and workforce development and will continue to address technology needs with CMS. We appreciate the updated resources and encourage members to access these funds for projects improving quality of care and quality of life for nursing home residents.
CMS Memo Answers Survey & Cert Questions
The Centers for Medicare & Medicaid Services (CMS) released a memo November 24 answering common questions about survey and certification recovery following the federal government shutdown that ended November 12. CMS announced that all survey and certification activities have resumed without limitation. State survey agencies will receive funding for the first quarter of FY 2026 and the first 30 days of the second quarter at rates equivalent to FY 2024 funding. The Continuing Resolution signed on November 12 also includes an additional $2 million to fund hospice recertification surveys under the IMPACT Act through January 30, 2026. As anticipated, state licensure surveys, which were permitted to continue during the federal government shutdown, will not be counted as federal certification surveys and federal certification surveys will still need to be completed, as will any lower-level complaint investigations that were completed during the shutdown under state licensure. Surveys that were in process when the shutdown began will resume and CMS clarified that a new survey does not need to be initiated, though resident/patient samples and other tasks may need to be updated. For surveys in which the team had exited but a CMS-2567 Statement of Deficiencies was not issued before the shutdown, state agencies must issue the CMS-2567 by December 12. Exit dates may be adjusted to match either the date that the CMS-2567 is issued or the date of compliance alleged by the provider, provided the state agency can validate that compliance was achieved by that date. Enforcement cycles, including dates for civil money penalties or Denials of Payment for New Admissions, may also begin with the adjusted exit date. For more information, check out QSO-26-02-ALL
CMS Finalizes Rules Eliminating Inpatient Procedure List, Without Changes to SNF Access
The Center for Medicare & Medicaid Services (CMS) will publish its final Calendar Year 2026 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates (CMS-1834) in the Federal Register on November 25. This final rule includes a provision for a three-year phase out 1700 plus surgical procedures from the “inpatient only list.” This change will allow physicians to authorize these procedures to be provided in an outpatient hospital, ambulatory surgical center setting or an inpatient hospital. Unlike current policy, these procedures will now be covered under Medicare in any of these settings. The phase out will begin January 1, 2026, by eliminating 285 primarily musculoskeletal procedures from the inpatient only list and adding most of them to the Ambulatory Surgical Center Covered Procedures List, shifting them to outpatient status. If a patient’s physician opts for these procedures to be provided outpatient, it eliminates the patient’s ability to access skilled nursing facility (SNF) services following the procedure as a Medicare covered service because there is no 3-day inpatient hospital stay. CMS responded to LeadingAge’s concerns about these potential impacts on beneficiaries’ access to SNF care saying they expect physicians to only approve these procedures for outpatient surgery in cases where their person will be able to return home without services or with home health services. It will be important for SNF members to track their admission patterns beginning January 1, 2026, to see if they experience a steep decline in admissions for musculoskeletal procedures. LeadingAge will continue to advocate for changes to the law regarding the 3-day inpatient hospital stay eligibility requirement. See LeadingAge’s article on the proposed rule for additional background and recommendations we proposed CMS adopt to remedy this limit on use of SNF services.
New White Paper Assesses Impact of Long-Stay Antipsychotics Measure
A new white paper released by Project PAUSE on November 19 assesses the impact of the Nursing Home Care Compare long-stay antipsychotics quality measure on access to appropriate treatment for nursing home residents experiencing neuropsychiatric symptoms related to Alzheimer’s and related conditions. The report asserts several unintended consequences of the measure, including a failure to distinguish between appropriate and inappropriate antipsychotic usage and a failure to reflect current clinical practice guidelines and makes recommendations to CMS for addressing these issues through revision or removal of the quality measure. Project PAUSE is a multi-stakeholder coalition, of which LeadingAge is a member, collectively advocating on regulatory issues related to the diagnosis and management of neuropsychiatric symptoms in dementia in long-term care. Learn more about Project PAUSE here.
A new white paper released by Project PAUSE on November 19 assesses the impact of the Nursing Home Care Compare long-stay antipsychotics quality measure on access to appropriate treatment for nursing home residents experiencing neuropsychiatric symptoms related to Alzheimer’s and related conditions. The report asserts several unintended consequences of the measure, including a failure to distinguish between appropriate and inappropriate antipsychotic usage and a failure to reflect current clinical practice guidelines and makes recommendations to CMS for addressing these issues through revision or removal of the quality measure. Project PAUSE is a multi-stakeholder coalition, of which LeadingAge is a member, collectively advocating on regulatory issues related to the diagnosis and management of neuropsychiatric symptoms in dementia in long-term care. Learn more about Project PAUSE here.
