What Nursing Homes Need to Know

 

On October 1, 2025, a U.S. federal government shutdown was announced. While the news may create uncertainty across healthcare sectors, nursing home operations are expected to continue with minimal immediate impact. The Centers for Medicare & Medicaid Services (CMS) released QSO-26-01-ALL, outlining how nursing homes will be affected during this period.

Here’s What You Need to Know:

Medicare & Medicaid Payments Will Continue
Medicare and Medicaid payments are considered mandatory spending, so funding for these programs will not stop. Nursing homes should continue receiving payments for services rendered.

Administrative Delays Are Likely
Longer wait times and limited access to agency staff should be expected. Due to staffing reductions at CMS, administrators, providers, and beneficiaries may have delays with:

  • Payment processing
  • Waiver approvals
  • Technical assistance requests

Federal Surveys & Certifications Limited
CMS has announced that only the most serious complaint investigations, those related to actual harm, will move forward. Other oversight activities are paused, including:

  • Routine recertification surveys
  • Inspections tied to less serious complaints\
  • Oversight activities of major CMS contractors

This means nursing homes may experience delays in routine compliance checks.

Independent Dispute Resolutions (IDRs) on Hold
No Independent IDRs will be conducted unless tied directly to a serious complaint that could result in immediate adverse action against a facility during the shutdown.

Exception: Revisit Surveys to Prevent Termination
State Survey Agencies (SAs) may request approval to conduct a revisit survey only if:

  1. A provider has alleged compliance with CMS requirements following a determination of noncompliance, and
  2. The revisit survey is necessary to confirm compliance and prevent scheduled Medicare termination, and
  3. The termination is imminent due to timing or specific circumstances.

Residential Surveys Will Continue
Residential surveys and complaint investigations outside of the federal oversight process will continue, ensuring resident care and safety are still being monitored at the state level.

Bottom Line:

While Medicare and Medicaid funding remains secure, nursing homes should prepare for administrative delays and limited federal oversight during the shutdown. Leaders should stay informed, document all compliance efforts, and prepare for longer turnaround times on requests made to CMS.

For details, read the full memo here: QSO-26-01-ALL.


Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

November is a time to give thanks and appreciate the people who mean the most. For older adults, one of the most meaningful “gifts” isn’t something you can wrap in a box. It’s the gift of independence. Being able to move safely, manage everyday tasks on your own, and enjoy conversations with friends and family makes daily life safer and more enjoyable.

 

How Therapy Helps You Live Your Best Life

Therapy isn’t just about exercise – it’s about helping you live your best life. Different types of therapy provide different kinds of support, but together they help you stay as independent as possible.

Physical Therapy helps you stay strong, steady, and confident on your feet. It reduces the risk of falls and keeps you active in the things you enjoy.

Occupational Therapy focuses on the little things that matter – like getting dressed, cooking a favorite meal, or enjoying hobbies and time with loved ones.

Speech Therapy supports clear communication and safe swallowing, making it easier to connect with others and enjoy meals together.

 

Talk to your doctor about therapy and how it could help you stay active and independent. Our therapy team specializes in helping older adults maintain and regain independence, so you can keep living life to the fullest.

Did you know?

One of the simplest ways to stay healthy as we get older is just… keep moving! Every movement you make, big or small, helps your body stay strong, flexible, and ready for whatever life brings.

But staying active isn’t always easy. Stiff joints, arthritis, or the natural changes that come with aging can make even simple activities, like going for a walk or climbing stairs, more challenging. That’s where physical therapy can help. Physical therapists are movement experts who work with older adults to make staying active easier, more comfortable, and safer.

How Physical Therapy Supports Healthy Aging:

Better Balance – Even small changes in balance can increase fall risk. Physical therapy helps identify these issues early and teaches strategies to keep you steady and safe.

Builds Strength– Gentle, targeted exercises to build muscle and stamina so you can enjoy everyday activities.

Manages Pain– Therapy can help reduce stiffness and soreness to make daily movement feel easier.

Promotes Independence – Staying active means staying in charge of your daily life and continuing to do the things you love.

 

If you’ve noticed changes in your balance, strength, or mobility, or if movement feels more challenging than it used to, talk with your doctor to see if physical therapy can help. Sometimes the smallest steps lead to the biggest improvements in health and independence.

What Providers Need to Know

 

On June 18, 2025, CMS issued QSO-25-20-NH, a memorandum to State Survey Agency Directors outlining significant updates to Nursing Home Care Compare aimed at improving transparency and enhancing performance measurement.

Key Highlights

  • Chain-Level Performance Data
    For the first time, CMS will begin publishing aggregate performance metrics for nursing home chains in a consumer-friendly format on Care Compare.
  • Health Inspection Rating Updates
    CMS will remove the third standard survey from the rating calculation, focusing only on the two most recent surveys.

    • Under the new weighting, the most recent standard survey = 75%
    • Second most recent standard survey = 25%
    • Weights for complaint and infection-control surveys continue to span a three-year period.
  • Updated Long-Stay Antipsychotic Measure
    The quality measure tracking long-stay residents on antipsychotic medications will now incorporate Medicare and Medicaid claims data and encounter records, alongside existing MDS data. The intent is to improve measurement accuracy.
  • Removal of COVID-19 Vaccination Data
    Resident and staff COVID-19 vaccination metrics will be removed from facility profiles on Care Compare.

 

Implementation Timeline

 

ChangeEffective Date
Health Inspection Rating (two-cycle rollout)Begins with the July 2025 Quarterly Refresh
Long-Stay Antipsychotic Measure UpdateBegins with the October 2025 Refresh

 

Implications for Providers

  • Understand chain-level insight
    Aggregated chain data can influence consumer perception and benchmarking. Review how affiliation metrics reflect on your organization.
  • Adjust focus to recent inspections
    With older survey data dropped, performance in recent inspections has heightened impact. Ensure corrective action plans are timely and visible.
  • Prepare for antipsychotic measure changes
    Broader data inputs may alter reported rates. Reassess antipsychotic medication use through both clinical review and coding integrity.

 

Why This Matters Now

These changes mark a meaningful evolution in how performance is measured and communicated to consumers. By placing greater emphasis on current inspection outcomes and incorporating more comprehensive data sources, CMS aims to deliver more accurate, actionable insights. Providers who understand and adapt to the recalibrated system can maintain both compliance and transparency.

Proactively Tackle Changes

  • Provide timely training on updated weightings and data sourcing.
  • Strategically brief staff on chain-level data interpretation and implications.
  • Use performance tracking tools to demonstrate improvement across inspection cycles.
  • Communicate assets to help explain changes to residents and families.

 


Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

Lessons from Recent OIG Audit Findings

 

A recent audit by the U.S. Department of Health and Human Services Office of Inspector General (OIG) revealed serious gaps in verifying nursing home staff background checks in Alabama. While the audit focused on one state, the implications are far-reaching and relevant for operators nationwide.

 

Key Findings from the OIG Audit (Alabama Audit A-04-24-08104)

The audit examined nursing home compliance between January 1, 2022, and April 8, 2024, reviewing 439 employees across sampled facilities. It was discovered that 139 employees did not have properly verified background checks or registry queries performed before beginning work.

Based on these findings, the OIG made four strong recommendations to the Alabama Department of Public Health (ADPH), urging:

  1. Implementation of a process to verify background checks and registry queries before employee onboarding.
  2. Education efforts to inform facilities about the critical importance of timely background verification.
  3. Requirement for facilities to establish formal policies and procedures for registry queries prior to employment.
  4. Conducting ongoing reviews of facility compliance with these requirements.

As of now, all four recommendations remain open and unimplemented, with further action expected by early 2026.

 

Broader Implications & Why This Matters Across States

Although this audit focused on Alabama, the risks and lessons apply universally:

  • Nursing home residents rely on trusted, screened staff. Lapses in background verification can significantly compromise safety.
  • Other states may face similar audits, and the trend toward heightened oversight is increasing, especially around employee screening procedures.
  • Like Alabama, other states could be prompted to institute mandatory pre-employment verification, backed by audits or sanctions.
  • Facilities lacking consistent background screening could face reputational damage, regulatory action, or worse.

 

Are you Compliance Ready?

 

Compliance ItemSuggested Action Item
Policy Audits & Gap AnalysisReview your current employee screening processes and identify areas vulnerable to OIG scrutiny.
Custom Procedure DevelopmentDraft and implement clear, state-compliant procedures ensuring registry and background checks are completed before onboarding.
Staff Education & TrainingDevelop trainings for HR and leadership teams on regulatory expectations and best practices.
Compliance Monitoring ToolsOffer checklists to track completion rates and trigger follow-up actions for missing verifications.

 

The OIG audit serves as a reminder that compliance cannot be reactive and instead must be built into daily operations. Nursing homes that establish robust, proactive screening processes not only reduce regulatory risk but also strengthen trust with residents, families, and communities. By taking action now, providers can position themselves as industry leaders in both resident safety and regulatory readiness.


Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

 

CMS has released the final Minimum Data Set (MDS) 3.0 Item Sets version 1.20.1v3 and the Item Matrix v1.20.1v3, which are now available in the Downloads section on the MDS 3.0 Resident Assessment Instrument (RAI) Manual page. These final updates will go into effect on October 1, 2025.

 

Why This Matters

The MDS drives not only resident care planning but also reimbursement, compliance, and quality reporting in skilled nursing facilities. Each update from CMS carries implications for providers, therapy partners, and facility teams who rely on accurate data collection and assessment.

With the final version now posted, providers should begin:

  • Reviewing the changes in detail, especially updates to Section GG and other areas impacting clinical workflows.
  • Educating interdisciplinary teams to ensure accurate documentation and coding.
  • Collaborating with therapy partners to align on how these updates affect care delivery, compliance, and outcomes reporting.

 

Key Changes

 

HTS Support

At HTS, we closely monitor MDS updates and provide guidance to ensure our partners remain compliant and prepared. Our team will share additional resources and training with our therapists, so they are equipped to navigate the October 2025 transition with confidence.

Visit CMS’ MDS 3.0 RAI Manual page to access the final item sets and matrix.

 


Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

Thanks to advances in medicine and nutrition, people today are living 10-15 years longer than just a few decades ago. A longer life gives you more time to enjoy hobbies, spend time with loved ones, and make new memories. But healthy aging isn’t just about adding years to your life—it’s about how well you feel during those years. By taking care of your body and mind, you can stay active, strong, and ready to enjoy every stage of life.

Here are some simple habits that make a big difference:

  • Sleep Well: 7–8 hours of sleep each night helps your body recover and keeps your memory sharp.
  • Move More: Sitting too long can affect your heart, muscles, and mood. Stand up and move every 30–60 minutes.
  • Strength Training: You don’t need a gym. Lifting soup cans or using resistance bands can help keep muscles and bones strong.
  • Brain Work: If you read often, try painting. If you do puzzles, learn a new instrument. Changing activities builds new brain connections.
  • Eat Superfoods: Blueberries are packed with antioxidants that help protect brain cells. Salmon is rich in omega-3s, which support heart health.
  • Find Joy: Laughter, music, and hobbies lower stress and boost your mood.

 

How Can Therapy Help?

Our therapy team specializes in helping older adults stay strong, steady, and active. Talk to your doctor about the benefits of therapy and how it can help you keep moving, stay independent and feel your best every day.

Join the #ProgressParade

 
HTS is excited to share a fun, special initiative from AHCA/NCAL called The Progress Parade—a grassroots campaign to celebrate the rehabilitation progress and success your residents achieve every day. Whether someone finishes therapy, meets a personal goal, or is heading home, this is a simple but powerful way to make that moment special.
 

See the Progress Parade in Action


Free Resources to Get Started

AHCA/NCAL has created a full Progress Parade Toolkit to make it easy to launch your own celebration.

 

Every year, one in three older adults experiences a fall—and many of these falls can be prevented. One of the biggest reasons for losing balance is muscle weakness, especially in the legs. Our legs support us as we walk, rise from a chair, climb stairs, and stay steady.

Why Leg Strength Matters

Around age 30, we begin to lose muscle mass in a natural process called sarcopenia. Over the decades, this gradual loss adds up. By our 80s, we may have lost up to half of our muscle strength. But here’s the good news: you can rebuild strength at any age. Simple, consistent movements can help you stay active, reduce the risk of falling, and maintain your independence.

 

Easy At-Home Exercises to Strengthen Your Legs

Here are a few ways to work leg muscles without special equipment:

 

March in Place — Do this while watching TV or listening to music. It’s a great way to get more steps in throughout the day.

Use a Stationary Bike — A gentle, low-impact exercise that helps build leg strength without putting pressure on your joints.

 

Chair Stands — Sit in a sturdy chair and stand up, then sit back down—repeat several times a day. This strengthens your thighs and helps with everyday mobility.

Walk While on the Phone — Instead of sitting during phone calls, walk around your home. These mini-walks add up!

 

Therapy Can Help Improve Balance & Prevent Falls

If you’ve had a fall or feel unsteady, talk to your doctor. Our therapy team specializes in strength and balance training to help you move more confidently, reduce your risk of falling, and stay independent.

CMS requires transparency regarding the ownership and management of certain healthcare facilities. If the required “additional disclosable party” information is not received, the provider’s ability to bill Medicare will be impacted due to potential denial or revocation of their Medicare enrollment.
Under Medicare rules, “additional disclosable parties” are individuals or entities that:
  • Have ownership or managing control interests in the provider or supplier,
  • Exercise operational or managerial control, or
  • Have an indirect ownership interest through another entity.
This disclosure is required to maintain transparency and prevent fraud, waste, and abuse.
Medicare Requirements: The Centers for Medicare & Medicaid Services (CMS) has implemented rules requiring facilities to disclose this information, particularly on the Form CMS-855A, which is used for enrollment and revalidation.

 

Consequences of Non-Compliance

Failure to provide accurate and timely disclosure of this information can lead to:

Call to Action

Assure you have disclosed the requested information on Form CMS-855A by 8/1/2025 so your Medicare enrollment is not at risk.