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Federal Government Shutdown

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

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Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Spotlights and Announcements

Now available! New Provider Data Catalog makes it easier to search and download publicly reported data. Also, Medicare’s Compare sites have been improved.

Notice of Upcoming SNF QRP Measure Removals – January 2024

The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program (QRP). The following quality measures are planned for removal from the iQIES Review and Correct Reports, Facility-Level Quality Measure (QM) Reports, and Resident-Level QM Reports in January 2024:

  • Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
  • Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients
  • Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients

Once removed from reports, users will no longer have access to any data or measure results for these measures.

Click here to read more.

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ATTENTION: We need your help to support this bill!

Legislation has been introduced to postpone the 15% reimbursement cuts to PTA and OTA treatments. Please help us to support this bill.

Dear Partners and Friends,

Please take a few minutes to read the below message from NASL regarding the new legislation that has been introduced in the US House. We need everyone to support this bill in order to postpone the 15% reduction in reimbursement for Med B services provided by PTAs and OTAs. This cut is set to happen on 1/1/2022. If this legislation is passed, it will delay this cut until 1/1/2023. Additionally, this bill allows for rural and underserved areas to be exempt from these cuts once they are implemented.

As skilled nursing operators and professionals, I urge each of you to take a few minutes to read the letter, make any additional edits/comments, and submit it to your personal representative. Spending a few minutes of your time could result in a very positive impact for our patients, as well as our industry. Your action is extremely time-sensitive because if this bill does not have enough support, it will not move on.

From NASL: Click here to access the letter and the ability to submit directly to your representative.

The time for advocacy on this issue is now as there is not much time left on the legislative calendar for Congress to act before this policy is implemented on January 1, 2022. NASL has prepared a letter for you to email to your respective House members urging them to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R.5536) and asking them to add the bipartisan legislation to any legislative packages moving before the end of the year.

Use the link above or visit https://app.govpredict.com/gr/m5bwzm-u to access and send this email in under two minutes.

Thank you for your time and effort to support this bill!

Sincerely,

Cassie Murray, President

 

Cassie Murray, OTR, MBA, QCP

President of HTS

Healthcare Therapy Services, Inc.

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Skilled Nursing Facility PEPPER Report Now Available

The fourth quarter fiscal year 2020 Program for Evaluating Payment Patterns Electronic Reports (PEPPER) are now available for skilled nursing facilities (SNFs) to download through the PEPPER Resources Portal. These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. This data can be used to support internal auditing and monitoring activities.

To obtain your SNF PEPPER report, please follow the following steps:

  1. Visit the PEPPER Resources Portal
  2. Complete all the fields; and
  3. Download your PEPPER report

Click here to visit the PEPPER Resources Portal.

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LTC Surveys to Resume in Indiana on 4/12/2021

On April 12. 2021, the Indiana Department of Health, Division of LTC will resume federal and state health surveys for both nursing homes an residential care facilities. All surveyors have been updated with the Long-term Care Survey Process (LTCSP) Procedure Guide that was effective February 6, 2021. Surveyors will review facility information 12 months prior to the survey entrance date, unless there is a need related to complaint or other concerns that would require information past the 12-month time frame.

Click Here for More Details on Nursing Home Surveys.

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CMS Announces Some Waiver Flexibilities As Ending Effective 5/10/2021

On April 9, 2021, CMS issued a new Memo to State Survey Agencies (QSO-21-17-NH) resulting in an end to a few waivers which were granted under the PHE.

The below flexibilities will end effective 5/10/2021:

  • The emergency blanket waivers related to notification of resident room or roommate changes, and transfer and discharge notification requirements
  • The emergency blanket waiver for certain care planning requirements for residents transferred or discharged for cohorting purpose
  • The emergency blanket waiver of the timeframe requirements for completing and transmitting resident assessment information Minimum Data Set (MDS)

Changes in QSO-21-17-NH were updated on April 8, 2021 and made available to providers via this link: COVID-19 Emergency Declaration Blanket Waivers for Health care Providers. Please note, waivers that will end effective 5/10/2021 are found on pages 18-19 of the linked document are in red, strikethrough font

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CMS Releases FY 2022 SNF PPS Proposed Rule

On April 8, 2021, CMS released the new Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule which, once finalized, is effective October 1, 2021. This proposed rule updates Medicare payment policies for facilities under SNF PPS for fiscal year 2022. The proposed rule also includes information for the SNF Quality Reporting Program (QRP) and SNF Value-Based Program (VBP) for FY 2022.

See below for the most significant areas of updates:

  1. FY 2022 updates to the SNF payment rates
  2. Methodology for recalibrating the PDPM parity adjustment
  3. Rebase and revision of the SNF market basket to improve payment accuracy under the SNF PPS
  4. New Blood Clotting Factor Exclusion from SNF Consolidating Billing
  5. Changes in PDPM ICD-10 Code Mappings – The ICD-10 code mappings and lists used under PDPM are available on the PDPM Website at: https://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/SNFPPS/PDPM
  6. SNF QRP update – modification to the public reporting SNF quality measures
  7. SNF VBP Program proposal to suppress the SNF readmission measure

For more information on this proposed rule, please visit the Federal Register’s Public Inspection Desk under “Special Filings,” at http://www.federalregister.gov/inspection.aspx.