Department of Education Proposes Narrower Definition of “Professional Degrees”
The U.S. Department of Education (DOE) has proposed revisions to the definition of “professional degree” that could have implications for federal student loan eligibility for certain graduate programs. This development is part of a negotiated rulemaking process that concluded recently aimed at implementing certain provisions of H.R. 1. Programs potentially excluded from the revised definition include positions vital to the aging services sector, including nursing and social work. Students in these fields could face reduced federal loan options and potential barriers to pursuing advanced credentials as a result of these changes. DOE will issue a Notice of Proposed Rulemaking (NPRM) soon, followed by a public comment period. Final rules are expected to take effect on July 1, 2026. LeadingAge will continue to monitor developments and share opportunities for member input.
LeadingAge WIN: Care Compare Updates
Following a letter to the Centers for Medicare & Medicaid Services (CMS) on November 13 requesting consideration of specific priorities following the end of the federal government shutdown, LeadingAge was notified that Nursing Home Care Compare was updated on November 20. The Health Inspection domain and rating had been frozen since August and was scheduled to update on October 29, along with the Staffing and Quality Measures domains and the overall Five Star rating as part of the quarterly refresh; however, the quarterly refresh could not take place during the shutdown. LeadingAge requested CMS to consider an off-cycle refresh rather than waiting for the next quarterly refresh in January 2026. We are pleased with this update that includes updates to all three domains and the overall Five Star rating. The next quarterly refresh is scheduled for January and will include a revised long-stay antipsychotics measure that incorporates claims data in the measure calculations. Read more on that change here. Providers that note any errors in their Five Star Rating or domain ratings should reach out to CMS using the Care Compare HelpDesk email bettercare@cms.hhs.gov.
CMS Finalizes Rules Eliminating Inpatient Procedure List, Without Changes to SNF Access
The Center for Medicare & Medicaid Services (CMS) will publish its final Calendar Year 2026 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates (CMS-1834) in the Federal Register on November 25. This final rule includes a provision for a three-year phase out 1700 plus surgical procedures from the “inpatient only list.” This change will allow physicians to authorize these procedures to be provided in an outpatient hospital, ambulatory surgical center setting, or an inpatient hospital. Unlike current policy, these procedures will now be covered under Medicare in any of these settings. The phase out will begin January 1, 2026, by eliminating 285 primarily musculoskeletal procedures from the inpatient only list and adding most of them to the Ambulatory Surgical Center Covered Procedures List, shifting them to outpatient status.
If a patient’s physician opts for these procedures to be provided outpatient, it eliminates the patient’s ability to access skilled nursing facility (SNF) services following the procedure as a Medicare covered service because there is no 3-day inpatient hospital stay. CMS responded to LeadingAge’s concerns about these potential impacts on beneficiaries’ access to SNF care saying they expect physicians to only approve these procedures for outpatient surgery in cases where their person will be able to return home without services or with home health services. It will be important for SNF members to track their admission patterns beginning January 1, 2026, to see if they experience a steep decline in admissions for musculoskeletal procedures. LeadingAge will continue to advocate for changes to the law regarding the 3-day inpatient hospital stay eligibility requirement. See LeadingAge’s article on the proposed rule for additional background and recommendations we proposed CMS adopt to remedy this limit on use of SNF services.
CMS Memo Answers Survey & Cert Questions
The Centers for Medicare & Medicaid Services (CMS) released a memo on November 24 answering common questions about survey and certification recovery following the federal government shutdown that ended November 12. CMS announced that all survey and certification activities have resumed without limitation. State survey agencies will receive funding for the first quarter of FY 2026 and the first 30 days of the second quarter at rates equivalent to FY 2024 funding. The Continuing Resolution signed on November 12 also includes an additional $2 million to fund hospice recertification surveys under the IMPACT Act through January 30, 2026. As anticipated, state licensure surveys, which were permitted to continue during the federal government shutdown, will not be counted as federal certification surveys and federal certification surveys will still need to be completed, as will any lower-level complaint investigations that were completed during the shutdown under state licensure. Surveys that were in process when the shutdown began will resume and CMS clarified that a new survey does not need to be initiated, though resident/patient samples and other tasks may need to be updated. For surveys in which the team had exited but a CMS-2567 Statement of Deficiencies was not issued before the shutdown, state agencies must issue the CMS-2567 by December 12. Exit dates may be adjusted to match either the date that the CMS-2567 is issued or the date of compliance alleged by the provider, provided the state agency can validate that compliance was achieved by that date. Enforcement cycles, including dates for civil money penalties or Denials of Payment for New Admissions, may also begin with the adjusted exit date. For more information, check out QSO-26-02-ALL.
KFF Looks at States’ Strategies to Constrain HCBS Spends
During KFF’s Annual Medicaid Budget Survey, states reported information on their Medicaid programs. Data collected during the report show that 44 of 50 states use limits on waiver enrollment, spending, or services to create budget predictability and curtail spending in home and community-based services (HCBS) programs. Recent analysis from KFF dives deeper into how states have used these tools in the past as a lens to understand how states are likely to constrain spending as they face crunches imposed by H.R.1. Authors break down waiver caps into populations served and total states deploying each kind of cap. The most commonly used tools by states are caps on spending per participant and caps on enrollment in a particular waiver; in both instances 37 of 50 states use these methods. Additionally, 47 states report using prior authorization for HCBS. Authors of the brief don’t venture into speculation about how states may respond to H.R.1-imposed budget shortfalls, though the data highlight the most likely policy levers for states to pull.
