November 9, 2026
On Nov. 5, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Cutting Administrative Requirements for Excellence in Patient Care (CARE) proposed rule (CMS-3484-P). The rule comes from a CMS review of the Conditions of Participation for all 21 provider and supplier types and proposes removing or revising requirements that the agency considers obsolete or overly burdensome. CMS estimates the full package would save about $320 million a year. Long-term care facilities account for the largest share, at an estimated $142.6 million a year.
What the Rule Would Change for Nursing Homes
NHSN respiratory illness reporting: CMS proposes to eliminate the ongoing acute respiratory illness reporting requirement at 42 CFR 483.80(g)(1), which currently requires facilities to report census, resident vaccination status, confirmed resident cases, and hospitalizations for COVID-19, influenza, and RSV through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). CMS estimates this reporting costs facilities about $61 million and more than 600,000 staff hours a year and says it has not identified corresponding improvements in resident health or safety. Reporting during a secretary-declared public health emergency (PHE) would remain. CMS would fold the needed data elements (census, confirmed resident and staff cases, hospitalized residents, supply and staffing shortages, and medical countermeasure inventories) into the PHE requirement and would drop resident vaccination status from it. CMS encourages facilities to keep reporting to NHSN voluntarily.
Staff COVID-19 vaccine education and offers: Facilities would no longer be required to educate staff about the COVID-19 vaccine, offer it to them, or document those steps. The requirement to educate residents and offer them the vaccine would remain, but CMS proposes streamlining it to align with the existing influenza and pneumococcal requirements. Documentation would cover two items: that education was provided, and whether the resident was immunized. If not, the record would note whether the reason was a medical contraindication or refusal. The separate education requirement for multi-dose vaccine series would be removed.
Facility assessment: CMS proposes to remove the requirement, added in the 2024 minimum staffing rule, that facilities ensure the active involvement of representatives of direct care staff in conducting the facility assessment. CMS notes that facilities have no authority over people who are not their employees or contractors. The rest of the facility assessment requirement at 483.71 would remain unchanged. CMS is also seeking input on best practices and technologies that could make the assessment process less burdensome.
Ombudsman notice for emergency transfers: Facilities currently must send the state long-term care ombudsman a copy of every transfer and discharge notice. Under the proposal, facilities would no longer send the ombudsman a copy for transfers to emergent care. CMS says the volume of these notices, often submitted as monthly lists, has made it harder for ombudsman offices to focus on inappropriate discharges. Notice to the resident and representative, the 30-day notice timeline for other discharges, and residents' appeal rights would stay in place.
Room occupancy and bathroom standards: Today, a facility newly certified after November 28, 2016, must limit bedrooms to two residents and provide each room with its own bathroom, including at least a commode and a sink. That means a building that changes ownership or experiences a lapse in certification may require major renovations before it can reopen. CMS proposes to tie these standards to the date state and local authorities approved construction or reconstruction plans instead of certification status, so existing buildings would not have to meet the standards just because of a change of ownership or a gap in operations.
Medicaid payment transparency reporting: CMS proposes to rescind state reporting requirements on the percentage of Medicaid nursing facility payments spent on compensation for direct care workers and for support staff, and the percentage of ICF/IID payments spent on support staff compensation.
CMS Request for Comments
CMS is not proposing changes in these areas yet, but is seeking input to help shape future rulemaking.
Physician assistant (PA) and nurse practitioner (NP) roles in skilled nursing facilities (SNFs): CMS is asking how it could expand the scope of practice of PAs and NPs in SNFs within current law. The agency notes that the Social Security Act requires that the care of every SNF resident be provided under the supervision of a physician, and that the statute allows states to permit delegation of physician tasks in Medicaid nursing facilities but not in SNFs. Under current regulations, the initial comprehensive visit in a SNF must be performed by a physician, and later required visits may alternate between the physician and a PA, NP, or clinical nurse specialist. CMS wants information on:
- Factors that affect access to SNF admissions
- The roles PAs and NPs fill now and how they could help address access problems
- Examples of physician collaboration with PAs and NPs and the measurable effect on resident outcomes and safety, including PA and NP roles in visits after the initial physician visit
- Resident and family preferences about the type of clinician providing care
- State and local restrictions that could affect a facility's ability to use any new flexibilities
Ombudsman discharge notice opt-out: CMS is asking whether residents who initiate their own discharge should be allowed to opt out of having the notice sent to the ombudsman, with the choice documented in the medical record. Questions include how staff would explain the option, how surveyors would verify that a discharge was resident-initiated, and what unintended consequences could follow.
Direct care workforce: CMS is seeking ideas on future policies to address workforce shortages in nursing facilities and ICFs/IID.
PALTmed is reviewing the proposed rule and will submit comments to CMS by the January 2027 deadline.