Nursing Home News 2026September4

Updates from DHHS Survey Department

This week we received several updates from DHHS survey department. This information will be shared with the department in greater detail on our Associations call on September 9th.

RN Waiver- There have been a few SNFs that have applied or asked questions regarding an RN waiver. This would allow the SNF to deviate from the 8 consecutive hours per day of RN coverage. Providers need to understand this is a long process, often taking months before a response is received. It will require the provider to provide a significant amount of information during the application and will require submission of documents supporting the efforts to recruit. It will also require a recertification survey to be completed prior to approval. The chances of CMS approving this waiver are very low. Providers should proceed with caution on this method to ensure staffing requirements are met.
Department will provide information on “FYI” that are documented during the survey process for areas that may not reach a citation. Citations may be issued even if there is a PIP in place if evidence does not show a decrease in the deficient practice or if the PIP was just recently implemented. Past non-compliance can also be cited if they have reached harm levels or for other reasons.

New MDS Resource Available from CMS

The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training that provides an overview of Chapter 2 of the Resident Assessment Instrument (RAI). The course reviews RAI requirements for OBRA and PPS assessments, including assessment types, timing and scheduling requirements, discharge assessment determination, interrupted stay considerations, and combined assessments. This training can be accessed through the SNF QRP Training webpage.

UHC Prior Authorization Reductions Will Have Little Impact on SNFs and HHAs

UnitedHealthcare announced September 1 that it will make a 30% reduction in the number of items and services requiring prior authorization across its Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs), Community Plans (Medicaid managed care), and commercial insurance products. However, LeadingAge’s review of the more than 1,700 affected codes found that few apply to skilled nursing facilities (SNFs) or home health agencies (HHAs)—a disappointing, though perhaps unsurprising, result for members.

There are three CPT Codes -- 92597, 92508 and 92526 that address speech-language pathology services and treatment of swallowing dysfunction and/or oral function for feeding. There are also some codes for home-based durable medical equipment like patient lifts and hospital beds that will no longer need to be pre-approved. These new prior authorization policies will take effect October 1, 2026.

UHC is one of the insurers that signed a June 2025 pledge to reduce prior authorizations across all of their insurance products but to date, these efforts typically ignore offering any relief for post-acute care(PAC) providers like SNFs and HHAs. This latest proposal and other announcements made earlier in the year appear to be their attempt to follow through on their public commitment.

Based upon an April 20, 2026, announcement, UHC plans to implement a rural provider prior authorization waiver starting November 2 to ease the administrative burden of this process on rural health providers. Few details about the waiver have been provided but it appears it will be limited to rural hospitals and their associated rural practitioners. It is not clear if this would also absolve these hospitals and practitioners from seeking initial prior authorizations for SNF or HHA admissions. If prior authorizations aren’t required to initiate a SNF stay or HHA admission, one can’t help but wonder if this will place a new burden of proof on SNFs and HHAs to prove medical necessity when they submit a claim for payment and/or lead to higher rates of claims denials. If that is the case, eliminating prior authorizations will merely shift provider burden from prior authorization to the point of seeking payment.

UHC acknowledges the “cost and staffing strains” that prior authorizations pose for rural providers but fails to recognize these requirements are equally burdensome for PAC providers especially given the frequency that requests for continued care must be submitted by SNFs and HHAs. LeadingAge members in 2024-2025 reported each SNF episode of care requires, on average, between 2-5 requests or authorizations to continue care beyond the initial prior authorization to ensure the beneficiary receives needed services.

The recent Office of the Inspector General report on MA prior authorization practices related to PAC services underscores high overturn rates of initial denials of prior authorization requests. These appeals are often supported by PAC providers taking direct care staff away from the beneficiary to obtain the needed approval from a plan.

LeadingAge is continuing its advocacy push to Congress and the Administration for standardization of prior authorization processes across plans and speeding up the decision making by the plans. We will be encouraging the House and Senate to vote on the Improving Seniors’ Timely Access to Care Act (H.R. 3514/S. 1816) when they return for their September session.

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