Nursing Home Network – Review the FY 2027 SNF PPS Rule
Join the Nursing Home Network on Thursday, May 7 at 3:30 p.m. ET to review the Fiscal Year 2027 Skilled Nursing Facilities (SNF) Prospective Payment Systems (PPS) proposed rule. The rule was released to the Federal Register on April 2 and comments are due by June 1. If you are not yet a member of the Nursing Home Network and would like to attend this call, email Jodi Eyigor.
Increasing Assisted Living Access through Medicaid, Housing Credits
The Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act (S. 4479), introduced on April 30 by Senator Roger Marshall, M.D. (R-KS), would make assisted living a covered Medicaid benefit for older adults who meet service need thresholds akin to someone needing nursing home or hospital care. The bill would also add a new emphasis required to how states prioritize their allocations of federal Low Income Housing Tax Credits. The new selection criteria would require states to consider how much an affordable housing development vying for some of the state’s LIHTCs would “reduce the medical assistance costs of long-term services and supports for the elderly by providing such services and supports in a non-institutional setting.” Rep. Max Miller (R-OH) is introducing a House version of the bill. “Medicaid spending is on an unsustainable path, and too many seniors are being pushed into higher-cost care they don’t actually need,” Senator Marshall said in a statement about the bill. “As a physician, I’ve seen the consequences of that firsthand. This bill is about giving states the ability to provide the right care in the right setting, while protecting the long-term future of Medicaid.” LeadingAge supports the bill while making crystal clear that states must retain assisted living oversight authority. “Making assisted living a covered Medicaid benefit for older adults brings affordability to a needed but often financially out of reach service and helps to reduce overall Medicaid spending for those whose needs can be met outside of more expensive nursing home settings. The Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act recognizes that while there is a nationwide opportunity to expand access to assisted living, there is no need for a one size fits all approach to circumvent existing state oversight of assisted living. As they steadfastly have, states must continue to lead the way on ensuring assisted living quality through their own guidelines that meet their unique needs. The bill does not just open up the benefits of assisted living to more older adults through the Medicaid program; it also expands the supply of affordable assisted living by improving the Low Income Housing Tax Credit program, the nation’s largest affordable housing development program, and better pairing it with long‑term services and supports so older adults can more affordably age in the community. LeadingAge is grateful for Senator Marshall and Representative Miller’s leadership on this legislation in the Senate and House, respectively. Together with the week’s earlier introduction of the Home and Community-Based Services (HCBS) Access Act by Representatives Dingell and Schakowsky, we are pleased to see Congress firmly step out and champion meaningful proposals under the umbrella of long-term care affordability,” LeadingAge said in a statement on the bill.
Senators Reintroduce CNA Lockout Bill
Senators Mark Warner (D-VA) and Tim Scott (R-SC) reintroduced on April 30 the Ensuring Seniors’ Access to Quality Care Act that will fix the CNA lockout that automatically bans nursing homes from training certified nurse aides for two years based on a civil money penalty above a certain threshold, even if the fines were unrelated to the quality of care provided to residents, unrelated to the quality of training, and were promptly identified and addressed to minimize impact and prevent recurrence. The bill also allows nursing homes to access the National Practitioner Data Bank (NPDB) to better screen and vet potential employees. Read the full text of this bill here. LeadingAge has endorsed this bill and will continue working with Senator Warner’s and Senator Scott’s offices to advance legislation.
Home and Community Based Services (HCBS) Access Act and Long-Term Care Workforce Support Act Reintroduced.
On April 30, Representative Debbie Dingell (D-MI) and Representative Jan Schakowsky (D-IL) reintroduced the HCBS Access Act which would make HCBS a permanent part of the Medicaid program as well as enhancing funding for HCBS and for the direct care workforce. LeadingAge supports the HCBS Access Act and will have an article on the bill in the coming days. The Long-Term Care Workforce Support Act led by Representative Dingell and Representative Matsui (D-CA) is a sweeping package that would invest in the direct care workforce through both grants and the Medicaid program as well as implementing a suite of worker protections and compensation requirements. LeadingAge is still reviewing the bill. The press release from Rep Dingell on both bills can be found here.
CMS Posts HCBS Quality Measure Set for 2028 State Reporting
Available in the Federal Register prior to the official posting on April 28, the Centers for Medicare and Medicaid Services (CMS) posted the Medicaid Program; 2028 Medicaid Home and Community-Based Services Quality Measure Set. The posting announces a 30-day public comment period on the set and proposes mandatory state adoption of the home and community-based services quality measure set, with reporting to commence on July 9, 2028, for 25% of measures. The remaining measures will be rolled in with 50% of measures being reported on by 2030, and full reporting necessary by 2032. The proposal by CMS to mandate quality measures in HCBS comes at a time when all additional transparency into service delivery and program integrity will support states’ policy decisions in light of ongoing scrutiny to fraud and program abuse. Measures will be reported on the aggregate, though stratified by participant age and wavier categories. Reponses will be based on surveys of participants’ abilities to access services, timeliness of service availability post enrollment, ability to access broader community supports, and amend service needs. Further analysis of the proposal is forthcoming as LeadingAge anticipates commenting on the proposal.
OIG Contends Nursing Homes Lack Adequate, Reliable Emergency Power Systems
A report released on April 29 from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) contends that most nursing homes in the United States do not have adequate or reliable sources of emergency power. This conclusion was based on a review of 100 sampled nursing homes at which OIG interviewed nursing home officials, reviewed emergency power system records, and completed site visits. From this audit, OIG determined that 72 of 100 nursing homes were noncompliant with federal requirements. A total of 119 deficiencies were identified through this audit to include inadequate maintenance of generators, inadequate circuit coverage, and generators that were out of date, quantified as aged 40 years or more. From these results, OIG estimates that 73% of all nursing homes in the United States have inadequate or unreliable emergency power systems. Specifically, OIG estimates that 53% demonstrate inadequate generator maintenance, 39% have generators with inadequate circuit coverage, and 10% have generators 40 years of age or older. OIG recommended that CMS share results of this audit with nursing homes and emphasize the importance of having adequate and reliable emergency power systems.
Department of Education Finalizes Rule Related to Federal Student Loan Limits
On May 1, the Department of Education will publish its final rule implementing changes to federal student loan limits for graduate and professional degree programs. The rule finalizes, without modification, the Department’s definition of “professional degree,” despite significant concern raised during the public comment period. LeadingAge is disappointed that the Department chose not to revise its approach. As we noted in our comment letter, the finalized definition could unintentionally but significantly harm the aging services workforce by excluding several fields that are integral to our sector, including advanced practice nurses, physician assistants, social workers, and rehabilitation therapists such as physical and occupational therapists. These professionals are essential to delivering high-quality care across provider settings. As a result of being excluded, students pursuing post-baccalaureate degrees in these fields will be subject to lower federal loan limits beginning on July 1, 2026. Litigation challenging the final rule is expected, and LeadingAge will monitor those developments closely. At the same time, we support the Professional Student Degree Act, a bill with bipartisan support that would clarify the definition of “professional degree” in federal statute to ensure key aging services professions are not excluded. As workforce shortages persist and demand for care continues to grow, LeadingAge will continue to advocate for federal policy that supports a strong and sustainable pipeline of highly skilled healthcare and social services professionals who serve older adults.
CMS Highlights Nurse Incentive Program
The Centers for Medicare & Medicaid Services (CMS) included information on its Nursing Home Staffing Campaign in its April 30 MLN Matters newsletter. The article advertised the nurse financial incentives program and noted that applications would be opening soon. This program will provide up to $40,000 in loan repayments and $10,000 living stipends to registered nurses (RNs), licensed practical nurses (LPNs), and licensed vocational nurses (LVNs) working in qualifying nursing homes for a commitment of three years. While CMS has still not released information about how “qualifying nursing homes” are determined, language in the notice seems to indicate that these nursing homes will be in areas that are designated “rural” and/or “underserved.” LeadingAge recently inquired about updates on the program and was told that more information would be coming soon. The updated webpage and mention of the nurse financial incentives in the MLN Matters article are welcome signs that CMS is moving this program forward.
States Required to Revalidate All Medicaid Providers Says Dr Oz in Letters to State Governors and Medicaid Directors
On April 23, CMS Administration Dr. Mehmet Oz posted on X that CMS had sent separate letters to states’ Medicaid Directors and governors. The letters ask states to take quick action on revalidation of high-risk providers in their Medicaid programs. CMS asks that:
- Within 10 days of the receipt of the letter, states must inform CMS whether the state intends to carry out a “swift revalidation of high-risk providers.” The letter to governors notes that “failure to do so will be considered as we evaluate the likelihood of fraud in each state moving forward.
- Within 30 days of the receipt of the letter, states must develop and submit a comprehensive two-year provider revalidation strategy. The strategy must include a description of the state ensures the accuracy of provider enrollment data through revalidation and other approaches. The letter to state Medicaid directors includes parameters to be included in the plans such as timelines, methodologies, data and information verification, and any necessary coordination with law enforcement.
CMS also says that states must submit their provider revalidation strategy results upon completion.
CMS notes that states have flexibility in determining what a “high risk provider” is but notes that providers with no National Provider Identification (NPI) number and those who have not been screened within the last 12 months are ones that states should consider for swift revalidation. CMS notes that states must include information on how they will assess provider enrollment for those without a NPI. Other letters from CMS to states like California have focused on home and community-based services providers including adult day, personal care, non-emergency transportation, and others, but the April 23 letters do not name any specific Medicaid service provider types as high risk (beyond a focus on those without NPIs).
A sample of the letter sent to governors can be found here. A sample of the letter sent to State Medicaid Directors can be found here. These samples are to the state of Alabama, but all states received these letters.
ICYMI – now on LeadingAge.org
CMS Urges Swift Review of High‑Risk Medicaid Providers
DEA Reschedules Certain Marijuana Products
DOL Issues Proposed Rule on Joint Employer Standard
Weekly recaps: Wednesday, May 6
