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 Read the unpublished version here.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.
