Advocacy Win: CMS Proposes Removal of COVID Vaccination Measures in FY 2027 SNF PPS Rule
The Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year 2027 (FY 27) Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule late on April 2. The rule proposes a 2.4% payment update for SNFs in FY 27 based on a 3.2% market basket update, less a 0.8% productivity adjustment. The rule does not propose any ICD-10 code mappings changes in the Patient-Driven Payment Model (PDPM) this year but does request information on addressing what CMS calls “case-mix creep,” the observed pattern of changes in coding or classification of residents that does not appear related to an actual changes in case mix.
In a win for LeadingAge, CMS proposes to remove two measures from the SNF Quality Reporting Program (QRP): COVID-19 Vaccination Coverage Among Healthcare Personnel and COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date. LeadingAge has consistently advocated for removal of these measures since their introduction and if finalized, SNFs would no longer be required to report COVID vaccination status of healthcare personnel through the National Healthcare Safety Network (NHSN) and the COVID vaccination item would be removed from the Minimum Data Set (MDS) for FY 27.
CMS additionally proposes to revise SNF QRP data submission guidelines and to expand SNF QRP to include data on all SNF patients regardless of payer, both proposals on which CMS has previously sought feedback. As anticipated, CMS is requesting feedback on Advance Care Planning as a future measure concept for SNF QRP. An Advance Care Planning measure was initially included in the December 2026 Measures Under Consideration (MUC) List but removed before the measure could be voted on for long-term care. CMS proposes to update “snapshot dates” for MDS measures in the SNF Value-Based Purchasing (VBP) program to be consistent with data submission guidelines proposed under the SNF QRP.
The proposed rule is expected to be published in the Federal Register on April 7. Read the unpublished version here. Read the CMS Fact Sheet here. LeadingAge will provide further analysis of this rule in the coming days. Comments on this proposed rule are due by June 1. LeadingAge will host a call in the coming weeks to solicit feedback from members to inform our comments.
CMS Releases Further Updates to Complaint Investigation Guidance
The Centers for Medicare & Medicaid Services (CMS) previously released significant updates to Chapters 5 and 7 of the State Operations Manual in January 2026. The updates were not changes to policy but rather updated the manual to be consistent with current policies and practices. On April 3, CMS made additional clarifications to Chapter 7 Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities. Note that the revised memo still shows the original January updates highlighted by red text, making it difficult to identify the April 3 changes.
In the revised memo, CMS clarified that abbreviated surveys must be completed on two consecutive calendar days beginning with the date of survey entrance. CMS also provided examples for enforcing per day and per instance civil money penalties (CMPs) and clarified that CMP amounts are hypothetical only, based on original amounts not adjusted for inflation, and that actual CMP amounts will be determined based on instructions in the CMP Analytic Tool, required for surveyors and available to providers and the public. The revisions will be applicable to all enforcement cycles starting on and/or after March 31, 2026. CMS further announced that per instance CMPs will be displayed on Nursing Home Care Compare beginning June 24, 2026. LeadingAge has asked CMS for more information on what this will look like.
Change in PBJ Data Submission Specifications
The Centers for Medicare & Medicaid Services (CMS) shared information with LeadingAge on April 2 that was previously sent to all providers submitting payroll-based journal (PBJ) data. We are re-circulating this information to members at CMS’s request:
The NEW FileSpecVersion 4.10.0 was originally scheduled to be effective on March 22, 2026. The NEW effective date is April 1, 2026. If you submit files using fileSpecVersion 4.10.0 before April 1st, the file will be rejected. Manual entry of staffing hours will continue to allow up to a maximum of 24.00 hrs/day until April 1, 2026 without causing a fatal error. Since facilities are required to deduct 30 minutes from each 8-hour shift, it’s not possible for a staff member to have more than 22.5 hours in a day. Therefore, the new version will not allow facilities to submit more than 22.5 hours in one day for any staff member. The OLD FileSpecVersions 2.00.0, 2.00.3, and 4.00.0 will continue to be accepted until March 31, 2026. If you submit files using fileSpecVersion 2.00.0, 2.00.3, or 4.00.0 on April 1, 2026, or after, the file will be rejected.
System updates will be implemented on March 31, 2026 beginning at 8 pm EST and is expected to take up to 4 hours. We recommend you complete any submission activity on March 31, by 7 pm EST. If you have files rejected during that time, you may need to resubmit on April 1 using 4.10.0. If you have manual data rejected, you should try again on April 1.
CMS Clarifies Nurse Aide Training Requirements
The Centers for Medicare & Medicaid Services (CMS) released a memo on April 8 clarifying certain federal requirements for nurse aide training programs. Recall that while CMS sets federal standards, each state is responsible for approving or disallowing nurse aide training and competency evaluation programs (NATCEPs) and competency evaluation programs (CEPs). While the April 8 memo does not contain new policy, the clarifications will be useful to providers interested in applying for a NATCEP or in states that are considering changing current NATCEP policies. CMS provides clarification on many topics including fees, supervision, instructor qualifications, the use of remote technologies in competency evaluations, and state and CMS location authorities to waive NATCEP disapprovals. Read more about these important clarifications here.
IRS Issues No Tax on Tips Final Rule
The Internal Revenue Service’s final rule on Occupations That Customarily and Regularly Receive Tips; Definition of Qualified Tips is available for public inspection with a publication date of April 13, 2026, in the Federal Register. This rule implements Section 70201 of the One Big Beautiful Bill Act which establishes a tax deduction of up to $25,000 for qualified tips. Qualified tips are defined as cash tips received by an individual in an occupation that customarily and regularly received tips on or before December 31, 2024, as provided by the Secretary of Treasury. The rule designates 71 such occupations, which include dining room attendants, personal care and service workers, hairdressers, and hairstylists. To be considered a “qualified tip,” the amount must: (a) be paid voluntarily without any consequence in the event of nonpayment; (b) not be the subject of negotiation; and (c) be determined by the payor. The “no tax on tips” deduction is in effect for the 2025 tax year and is set to expire after the 2028 tax year. Watch for an analysis of this final rule from LeadingAge in the coming days.
New Medicare Audit on Home Health Long-Length of Stay
On April 6, 2026, Noridian Healthcare Solutions, LLC (Noridian), the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare and Medicaid Services, posted a new project to their website, 01-158 Home Health Longer Days Notification of Medical Review. Noridian will be conducting a post-payment review of claims for Medicare Part A Home Health billed between January 1, 2024, and December 31, 2024. Noridian will be conducting data analysis and medical review activities on home health services within the recertification period when provided greater than or equal to 361 days. The reasons for the review state that under the Patient Driven Groupings Model, reductions in therapy utilization and reimbursement‑driven adjustments to care may introduce potential vulnerabilities in payment, particularly for home health services provided for 361 days or longer. This was based on internal CMS data which was not shared in the project overview. As part of the project, Noridian cites a number of references to patient education or teaching and training programs at both the Medicare National Coverage Determinations and Local Coverage Determinations. The details also include other maintenance-based services like monitoring glucose control.
Over the last several years, researchers have seen a growth in the length of stay for many home health, particularly in community-entry episodes, which now make up a little less than half of all episodes, driven mostly by for-profit providers. The additional documentation requests are asking for a considerable amount of information from both the initial and recertification periods for these individuals. LeadingAge will continue to monitor this audit.
Highlights of President’s Budget Request for CMS and CDC
The President’s Budget Request was released on April 3. LeadingAge released an overview of topline budget requests impacting LeadingAge members. A deeper dive into the HHS budget, highlighting key requests for CMS and CDC, is available here. The President’s annual budget request is regarded as a messaging tool for the administration; members of Congress draft their own funding bills for various programs, including programs impacting older adults and those who serve them. LeadingAge will continue to monitor the annual appropriations process.
Lobby Day Materials
Materials for LeadingAge’s April 22 Lobby Day are now available here, under “Lobby Day April 2026.” Materials include our Quick Look Talking Points, a List of Key Bills, and overviews of our asks for Affordable Senior Housing, Aging Services Workforce, Home & Community-Based Care, Hospice, Medicare Home Health, Medicare & Medicare Advantage, and Nursing Homes.
Weekly Recaps: Wednesday, April 8
LeadingAge National Government News: April 15, 2026
CMS Phases Out the Fax Machine
The Centers for Medicare & Medicaid Services (CMS) released a final rule on March 24 widely dubbed as “phasing out the fax machine.” The Administrative Simplification; Adoption for Standards for Health Care Claims Attachments Transactions and Electronic Signatures rule seeks to improve health interoperability by setting standards for secure exchange of healthcare information claims-related processes. The rule eliminates manual processes such as faxing and mailing and requires implementation by May 26, 2028. Read the CMS Fact Sheet here.
LeadingAge will provide further analysis of the rule in the coming days. LeadingAge Kansas will be doing additional work through the Rural Health Transformation Alliance to identify how those funds can be strategically utilized for compliance with this rule, as well as seeing what other funding opportunities may be available to help with this process. We’ll also be in consultation with KDHE for additional guidance or information they may have to offer through the state’s HIE program.
COVID “Up to Date” Definition Will Not Change
LeadingAge has learned from the Centers for Disease Control & Prevention (CDC) that the definition of “up to date” for COVID vaccination will remain the same for Quarter 2 reporting to the National Healthcare Safety Network (NHSN), which begins on Monday, March 30. The current definition, which expires on March 29, states that individuals aged 65 years and older are “up to date” with two doses of the 2025/2026 vaccine (or at least one dose in the past six months) and individuals under the age of 65 are “up to date” with one dose of the 2025/2026 vaccine. CDC intends to update the “key terms” document by early April. Recall that although respiratory illness season generally ends on March 31, nursing home providers are required to continue weekly reporting of respiratory illness data and monthly reporting of COVID vaccination status of healthcare personnel through NHSN.
Flu Vaccination Status Reporting Due May 15
With the general end of respiratory illness season approaching on March 31, nursing home providers are reminded of requirements to report flu vaccination status of healthcare personnel. Nursing homes must submit one report through the Healthcare Personnel Safety Component of the National Healthcare Safety Network (NHSN) by May 15 that reports the flu vaccination status of all healthcare personnel working in the nursing home at least one day during respiratory illness season (October 1 – March 31). This requirement is part of the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and nursing homes that fail to submit data will see impact on the Annual Payment Update (APU).
New SNF Reports Now Available in LeadingAge Report Portal
New Five Star Reports are now available for nursing home members in the LeadingAge Report Portal. These reports are based on the March 25 update to Nursing Home Care Compare data. Being a monthly update, only the Health Inspection domain data was updated. A small number of providers may notice a change in their Health Inspection domain ratings or overall Five Star ratings based on these updates, but for most providers, no changes will be noted. The next quarterly refresh updating all three domains and the overall Five Star rating will take place in April.
CMS Expects Incorporation of New Food Guidelines
The Centers for Medicare & Medicaid Services (CMS) issued a Quality and Safety Special Alert memo (QSSAM) on March 30 reminding hospitals of their obligations related to patient food and nutrition services. Specifically, CMS expects incorporation of the new Dietary Guidelines for Americans 2025 – 2030, released in January 2026 as part of the Administration’s Make America Healthy Again initiative. While this QSSAM was directed at hospitals, nursing homes should be aware of this directive. CMS has not issued a nursing home memo but recall that requirements at 42 CFR 483.60(c) call for menus to be developed according to “established national guidelines.” In the memo, CMS outlines eight “Key Elements” of the new guidelines to be considered in meeting requirements. This includes recommendations such as limiting ultra-processed food options, eliminating refined grains in favor of 100% whole grains, and ensuring meals contain less than 10 grams of added sugar. CMS includes examples of food and beverage options such as replacing processed deli meats with freshly prepared lean protein options and avoiding offering sugar-sweetened beverages or juice. LeadingAge will be watching for any nursing home-specific information but know that state and federal surveyors would not need a specific memo or directive to survey on these guidelines as “established national guidelines.”
Small Business Administration, Office of Advocacy Roundtable on DOL Independent Contractor Rule
The Small Business Administration’s Office of Advocacy will be holding a Roundtable on April 9, relating to the Department of Labor (DOL)’s proposed rule on employee or independent contractor status under the Fair Labor Standards Act (FLSA) and certain related federal laws. The rule proposes to revise how employers determine whether a worker is an employee or an independent contractor and would rescind the agency’s 2024 final rule and replace it with a framework similar to the standard adopted in 2021 during the first Trump administration.
Under the proposed rule, the test for determining worker classification would place greater emphasis on two core factors: the nature and degree of control exercised over the work, and the worker’s opportunity for profit or loss based on initiative or investment. If both core factors point to the same classification, that outcome is likely to prevail. Additional considerations—the level of skill required, the permanence of the working relationship, and whether the work is part of an integrated unit of production—may still be considered but would carry less weight than the core factors. The proposal is a shift away from the 2024 rule’s “totality of the circumstances” approach, which treated a non-exhaustive list of factors equally in determining worker classification. The agency believes the new rule will offer greater flexibility and clearer guidance for organizations that use independent contractors, while potentially reducing misclassification risk and related litigation.
The Roundtable will include a briefing by DOL of the proposed rule, as well as an opportunity to provide feedback on the rule. The Office of Advocacy is responsible for monitoring compliance with the Regulatory Flexibility Act, which seeks to minimize the regulatory burden on small entities. Small entities consist of small businesses, small governmental jurisdictions, and small organizations—the latter of which are generally defined as any not-for-profit enterprise which is independently owned and operated and is not dominant in its field. The Roundtable affords small entities potentially impacted by the proposed rule the opportunity to share their opinion on the rule with the Office of Advocacy virtually.
Please note that presentations made during this roundtable will not substitute for written comments to DOL and therefore, members wishing to comment on the rule should submit written comments to the rulemaking docket. The comment period for the proposed rule closes on April 28.
Representatives Introduce Nursing Home Minimum Staffing Standards Bill
Representatives Lloyd Doggett (D-TX) and Jan Schakowski (D-IL) introduced the Safe Staffing Saves Lives Act on March 26 to establish minimum staffing standards in nursing homes. The House bill comes weeks behind a bill introduced in the Senate and contains significantly more provisions. In addition to a requirement for 24 hours per day, 7 days per week of registered nurse (RN) staffing, the bill would require nursing homes to provide 4.1 hours per resident, per day (HPRD) of total nurse staffing. This 4.1 HPRD would include at least 1.3 HPRD of “direct licensed nursing care” divided between 0.75 HPRD of RN staffing and 0.55 HPRD of licensed practical nurse (LPN) staffing, and 2.8 HPRD of certified nursing assistant (CNA) hours. These requirements are higher than both the Senate bill introduced in February 2026 and the regulatory requirements repealed in December 2025.
The bill further establishes penalties for failure to meet staffing standards including increased surveys and exclusion from the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) program and state directed payment programs, among other more traditional penalties like denials of payment. The bill includes provisions for a waiver and requirements for notifications of noncompliance similar to the parameters outlined in the Centers for Medicare & Medicaid Services (CMS) minimum staffing standards rule. If passed, the standards in this bill would be required to be implemented January 2029. LeadingAge does not support this bill. Workforce shortages and inadequate Medicaid reimbursement remain critical challenges for our members as they work tirelessly to provide quality care to nursing home residents. LeadingAge will be working with Hill staff to address these issues as we monitor the progress of this bill.
