Nursing Home News 2026June12

Updates from DHHS Survey Department.

As a recap of our provider/surveyor call on Wednesday, here are your highlights. 

Regulatory Information

Larissa covered that the state is currently running at a 16.5 months for recertification survey schedule for nursing homes. She also stated they welcome feedback at anytime (before, during, and after a survey). Larissa also announced that Ron Chase, survey supervisor for Omaha and Norfolk will be retiring at the end of the month. We would like to thank Ron for his dedication to the field of long term care and his many years of service. Larissa also covered the following topics this week:



• Assisted Living Staffing Resources including staff for supervision, health and safety as outlined in the service agreement. You must have at least 1 staff on when necessary to provide care and service.
• Assisted Living RN staff are responsible for medication administration policies, staff training and supervision. RN’s working in AL settings must abide by the scope of the AL regulations and may not be able to practice with all RN criteria. The person responsible for direction and monitoring is the decision maker on holding medications, etc.
• For nursing homes, she covered F558, F559, and F560. 

We will have the recording of this session in a future update when it is available. Handouts are available here. 

Reminders on PBJ Submissions

Life Safety Code: Doug discussed:

• Ensuring to fill out your POC and be ready for a revisit on any citations. Corrections should be made by the revisit so they do not need to return. There have been instances with multiple follow ups needing to occur. Corrections should be made within 60 days. Those not completed within 90 days may incur penalties or disciplinary actions.
• Reminders for hot weather and temporary cooling systems- you can see information from Doug on extreme weather conditions here.
• Heat in attics may cause sprinkler systems to go down. As a reminder, anytime a sprinkler or fire system is down, you must implement a fire watch policy. This is for planned or unplanned outages. This must be implemented if a sprinkler system is down for 10 hours or an alarm system is down for 4 hours.
• Reminders about safety for 4th of July celebrations- there are severely dry areas in Nebraska. Please keep everyone safe during this time. 
  

We have had a few providers that have received a downgrade to one star due to missing or inaccurate PBJ submissions according to CMS. Although many did have proof of hours worked, they are unable to be disputed because the timeline has passed. Please note the following reminders about PBJ submissions: 

• The staffing rating calculation is based on the hours reported through the Payroll-Based Journal (PBJ) system each quarter. All staffing data that are received by CMS must pass a series of edits to be used in the calculation of the Five-Star Ratings and to be displayed on the Care Compare website. The April, May, and June 2026 staffing level measures (total nurse staffing, RN staffing, and weekend staffing) are based on PBJ data submitted by the February 14, 2026 deadline for the period of October 1, 2025 - December 31, 2025.
• The following criteria are used as the usual scoring rules for assigning the staffing rating.

1. Providers that fail to submit any staffing data by the required deadline will receive a one-star staffing rating for the quarter.
2. Providers that submit staffing data indicating that there were four or more days in the quarter with no RN staffing hours (job codes 5-7) on days when there were residents in the facility will receive a one-star staffing rating for the quarter.
3. CMS conducts audits of nursing homes to verify the data submitted and to ensure accuracy. Facilities for which the audit identifies significant discrepancies between the hours reported and the hours verified or those who fail to respond to an audit request will receive a one-star staffing rating for three months.

• Facilities are required to have an RN onsite at least 8 consecutive hours a day, 7 days a week under sections 1819(b)(4)(C) and1919(b)(4)(C) of the Act, and 42 CFR §483.35(b). The specific PBJ job codes used in the RN, LPN, and nurse aide hours calculations are described below:
• RN: includes RN director of nursing (job code 5), registered nurses with administrative duties (job code 6), and registered nurses (job code 7)
• LPN: includes licensed practical/licensed vocational nurses with administrative duties (job code 8) and licensed practical/vocational nurses (job code 9)
• Nurse aide: includes certified nurse aides (job code 10), aides in training (job code 11), and medication aides/technicians (job code 12)



• It is not possible to correct or submit any new information for previous periods because CMS will not accept any data after the PBJ submission deadline. After submitting the PBJ data there are reports that can be run in the CASPER system to ensure the accuracy and completeness of the data, these include: 1700D (employee report), 1702D (individual daily staffing report), and 1702S (staffing summary report). Please run these reports leaving sufficient time to review and correct any discrepancies before the submission deadline has passed. Instructions on how to run PBJ reports in the CASPER system can be found in the Casper Reporting User’s Guide for MDS Providers under Section 12 – Payroll Based Journal (PBJ) Reports at the following link: https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals.
• If you continue to have questions about the specific PBJ data submitted by your facility or how to access the validation reports, please contact the QIES/iQIES Helpdesk at 800-339-9313. The staffing rating is updated quarterly in January, April, July, and October of each year.  The PBJ data (from January 1 – March 31, 2026) submitted by the May 15, 2026 deadline will be used to calculate all six staffing measures with the July 2026 refresh.

Senators Call for Restart of Off-Cycle Revalidations

Senators Cory Booker (D-NJ), Ron Wyden (D-OR), and Elizabeth Warren (D-MA) sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz on June 3 urging CMS to immediately reinstate the skilled nursing facilities (SNFs) off-cycle revalidations. The off-cycle revalidations, which sought to provide greater transparency about the ownership, management, and financial ties of CMS-certified SNFs, were suspended indefinitely in December 2025 after multiple delays due to issues with the process. Issues included confusion among providers about what exactly to report, difficulty obtaining the required data from the entities to be reported, and a lack of clarity from CMS and consistency among the Medicare Administrative Contractors (MACs) responsible for processing the off-cycle revalidations. In the letter to CMS, the Senators contend “greater transparency into ownership and control is essential to protect residents, safeguard public funds, and enhance oversight of the nursing facility sector.” The Senators outline a troubling example of a complex network of related companies through which two nursing homes’ funds were tunneled while nursing home quality and staffing suffered. Cases like this highlight the need for improved transparency. However, the significant concerns identified with the CMS form and guidance by which nursing homes were required to report information on off-cycle revalidations underscore the need for CMS to re-evaluate this form and process. To improve nursing home ownership and management transparency in a meaningful way, CMS must develop a process that ensures the right information is acquired in the most efficient way.

Here is your NATIONAL Nursing Home Weekly Recap