Updates

Important CMS Updates for Skilled Nursing Facilities

On April 22, 2024, the Centers for Medicare and Medicaid Services (CMS) released the final rule regarding Minimum Staffing Standards for Long-Term Care Facilities requirements in nursing homes and Medicaid Institutional Payment Transparency Reporting.

Highlights of the released final rule include:

• An RN is to be on-site 24 hours per day/seven days per week.

• A minimum total staffing HPRD of 3.48, which includes all RNs, LPNs/LVNs, and nurse aides.

• A minimum RN staffing HPRD of 0.55

• A minimum NA staffing HPRD of 2.45

All four of the staffing requirements must be met to be considered in compliance. If the acuity needs of the resident require a higher level of care, a higher total, RN and NA staffing level will likely be required.

Exemptions may be available, but only in limited circumstances and include meeting all of the following criteria:

• The workforce is unavailable as measured by having a nursing workforce per labor category that is a minimum of 20 percent below the national average for the applicable nurse staffing type;

• The facility is making a good-faith effort to hire and retain staff;

• The facility provides documentation of its financial commitment to staffing;

• The facility posts a notice of its exemption status in a prominent and publicly viewable location in each resident facility; and,

• The facility provides individual notice of its exemption status and the degree to which it is not in compliance with the HPRD requirements to each current and prospective resident and sends a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.

A notice of a facility's exemption status and the degree to which it is not in compliance with the requirements will be posted on Care Compare. 

(NOTE: Exemptions are only valid until a facility’s next annual survey.)

Not eligible for an exemption if:

• The facility has failed to submit payroll-based journal (PBJ) data in accordance with re-designated 483.70(p);

• Is designated as a special focus facility (SFF);

• Has been cited for widespread insufficient staffing resulting in actual harm or a pattern of insufficient staffing resulting in actual harm; and has not been cited at the “immediate jeopardy” level of severity within the 12 months preceding the survey where facility’s non-compliance is determined by CMS; or

• Has been cited at the “immediate jeopardy” level severity with respect to insufficient staffing within the 12 months preceding the survey during which the facility’s non-compliance is identified.

CMS has revised:

• The existing Facility Assessment requirements 

• State Medicaid reporting requirements on the percent of payments for Medicaid-covered services in nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) 

CMS will use a Multi-stage implementation process will be used for the noted requirements, allowing facilities sufficient time to prepare. 

It is recommended that the final rule be reviewed in its entirety. 

Fact sheet

SNF VBP Program Early Look Performance Score Reports are Now Available

The Early Look Performance Score Reports for the fiscal year (FY) 2026 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program is now available to download via the Internet Quality Improvement and Evaluation System (iQIES).

Beginning the FY 2026 Program year, the SNF VBP Program is expanding to assess performance on multiple quality measures (QMs) rather than a single measure. The Early Look Performance Score Report is intended for informational purposes only and hopes to accomplish three goals for the newly expanded SNF VBP Program:

1. Familiarize SNFs with the planned format of the official Performance Score Report that will be distributed for the FY 2026 Program year.

2. Familiarize SNFs with the scoring and payment methodology that will be applied for the FY 2026 Program year.

3. Inform SNFs of past performance on the four quality measures adopted for the FY 2026 Program year, and model performance for the FY 2026 SNF VBP Program year using this historical data.

They do not reflect facilities’ official performance in the SNF VBP Program and will not impact facilities’ payments; CMS will share official performance information for the FY 2026 Program year based on updated measure data at a later date.

The SNF VBP Program’s confidential feedback reports are available through iQIES. Follow the instructions listed below to locate your SNF’s Early Look Performance Score Report:

1. Log into iQIES using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password. (If you do not have a HARP account, you may register for a HARP ID.)

2. In the Reports menu, select My Reports.

3. From the My Reports page, locate the MDS 3.0 Provider Preview Reports folder. Select the MDS 3.0 Provider Preview Reports link to open the folder.

4. Here you can see the list of reports available for download. Locate the desired SNF VBP Program Early Look Performance Score Report (file name: SNFVBP_[CCN]_FY26_ELR_Apr2024.xlsx).

5. Once located, select More next to the SNF VBP Program Early Look Performance Score Report and the report will be downloaded through your browser. Once downloaded, open the file to view your facility’s report.

For additional questions about accessing your SNF’s report, which can only be accessed in iQIES, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or by email at iqies@cms.hhs.gov.

For more information about the SNF VBP Program Early Look Performance Score Reports, including additional resources like a summary fact sheet and user guide, please visit the CMS website.