Nursing Home News 2026August21

New MDS Training from CMS: Section K Assessment and Coding Essentials.

The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training that provides an overview of Section K of the Minimum Data Set (MDS). The course reviews the purpose, assessment steps, coding instructions, coding tips, key definitions, and calculation methods for accurately assessing and coding Section K items. This training can be accessed through the SNF QRP Training webpage.

PBJ Reporting Due August 14; Last Submission to QIES

Nursing homes must submit Payroll-Based Journal (PBJ) data for Fiscal Year 2026 Quarter 3 by August 14. As noted in a July 14 memo from the Centers for Medicare & Medicaid Services (CMS), Fiscal Quarter 3 will be the last quarter for which nursing homes submit PBJ data through QIES. Beginning on August 17, 2026 for Fiscal Quarter 4, nursing homes will submit all data through iQIES. Remember that no data submitted after the August 14 reporting deadline will be accepted for calculating quality measures for the Five Star Quality Rating System and the Skilled Nursing Facilities (SNF) Quality Reporting Program (QRP). Nursing homes should submit in advance of the August 14 deadline and run applicable reports through QIES/CASPER to ensure that data has been received and appears as the nursing home expects. CMS memo QSO-26-12-NH provides information on how these reports will be run in iQIES following the August 17 transition. 

LeadingAge Underscores the Risk of MAO Dominance to GAO.

LeadingAge requested an August 17 meeting with the Government Accountability Office (GAO) to inform its current work gathering information for a 2027 Medicare Advantage report requested by Sens. Ron Wyden (D-OR), Catherine Cortez Masto (D-NV), Mark Warner (D-VA), and Elizabeth Warren (D-MA). Our goal was to ensure that skilled nursing facility (SNF) and home health agency (HHA) providers’ challenges, related to contracting with Medicare Advantage Organizations (MAOs), are understood through not only the lens of our members’ financial viability but also the risk MA and managed care dominance could pose to Medicare beneficiary access to care and services. The GAO report will examine CMS oversight of Medicare Advantage (MA) provider network adequacy requirements, including how beneficiaries are informed of significant network changes and alternative care options; current network adequacy exception requests and approvals; and factors influencing provider participation in MA networks. In response to GAO’s questions, LeadingAge shared member feedback about their interest and sometimes frustration in contracting with MA plans to be in network, how contract negotiations really work (e.g. MAOs often have all the leverage to dictate terms), and how frequently providers are dropped from networks or choose to terminate an MA plan contract and the reasons for those decisions. We also took the opportunity to highlight concerns and make recommendations related to monitoring and addressing the negative effects of MA plan market dominance and its impact on providers’ ability to secure adequate reimbursement. We emphasized the direct connection between beneficiary access to care and provider payment adequacy under MA. Specifically, we explained the reality that contracting with an MAO brings significant administrative burden — prior authorizations, payment claw backs, appeals — increasing providers’ costs, while MAO contracts pay those same providers less than traditional Medicare. GAO staff were particularly interested in the challenges SNFs and HHAs face in providing quality care to MA enrollees. We described delays in patient admissions caused by initial prior authorization requirements, as well as the need for subsequent approvals to support the person's recovery and condition maintenance. We noted how costs of care are being shifted from MA plans to providers and MA enrollees when care is prematurely terminated or provider networks are inaccurate resulting in no available in-network provider. We also discussed the financial and health consequences of delayed care and the cycle of authorizations, terminations, and appeals experienced by older adults enrolled in MA. Finally, we noted that current law limits CMS’s oversight role in ensuring MA plan networks include high-quality providers and that provider payments are sufficient to maintain access to care. GAO guaranteed our feedback will remain anonymous but will be incorporated into its early 2027 report. Reports from nonpartisan agencies such as GAO can help build support for future policy changes.

Nursing Home Network, August 25.

The Nursing Home Network will meet next Tuesday,  August 25 at 2 p.m. ET. We will review nursing home policy updates from the past month and discuss various questions posed by network members. The Nursing Home Network is open to all LeadingAge members and you can register for these calls here.

Medicare Part A Cost Report Overpayment Default Recoupment Date Extended.

The Centers for Medicare & Medicaid Services (CMS) announced in an August 7 MLNMatters newsletter that they are extending the Healthcare Integrated General Ledger Accounting System default recoupment date for Past A cost report overpayments from 16 to 41 calendar days after the demand date. This change will take effect January 4, 2027 and affects home health agencies, hospices, and skilled nursing facilities, among other providers billing Medicare Part A. CMS states that this change aligns with default recoupment dates for Medicare Part B overpayments. For Part A cost report overpayments that are not paid in full by day 40, recoupment will begin on day 41 unless the overpayment falls into an excluded category. For more information, refer to MM14457 or contact your Medicare Administrative Contractor.

Nursing Home Risk-Based Survey Resources Now Avaliable. 

The Centers for Medicare & Medicaid Services (CMS) released survey resources on August 13 for the new Risk-Based Survey that will be rolling out for nursing homes nationwide beginning in September. Available on the Nursing Homes page of the CMS website in the Downloads section, the survey resources include the typically-available resources used by state survey agencies during standard recertification surveys, adapted for use on the Risk-Based Survey. Training videos will also be available on the Quality, Safety and Education Portal (QSEP) in the future but are not available yet. The Risk-Based Survey is an exciting step forward in survey and certification reform and we appreciate CMS continuing to make survey resources publicly available. Reviewing these resources will help nursing homes know what to expect from surveys utilizing this new survey model. Recall, however, that CMS estimates approximately 12% of nursing homes will qualify for a Risk-Based Survey and not all qualified nursing homes will receive this survey model. For this reason, nursing homes should continue to refer to the standard recertification survey resources and the State Operations Manual (Chapter 7 and Appendix PP) to assist with compliance and survey preparation activities.

Feedback requested: Dialysis and SNF Patients.

In the Calendar Year 2027 End-Stage Renal Disease proposed payment rule, the Centers for Medicare & Medicaid Services (CMS) included a Request for Information related to supporting patients on home dialysis during transitions of care. Specifically, they note that “patients often discontinue home dialysis following hospitalization or skilled nursing facility (SNF) admission.” CMS requests feedback on the following:

• What policies would encourage continued use of PD in SNFs when clinically appropriate?
• Whether CMS should consider payment adjustments or demonstrations to incentivize SNFs to support home dialysis modalities.
• What additional health and safety requirements should be considered for ESRD facilities or nursing facilities to support continuity of modalities and ensure the safe delivery of home dialysis in this setting?
• What recommendations would improve the transition of dialysis patients between different care settings (hospital, institutional, and home)?
• Are ESRD facilities receiving electronic admission, transfer, and discharge notices as patients transition through hospitals so that they can monitor and track their patients? If not, why?

Based on this line of questioning, it appears CMS may be considering a few different strategies, including financial incentives and additional regulatory requirements for SNFs. Any thoughts? Please share with Jodi Eyigor jeyigor@leadingage.org by Thursday, August 20.

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