Washington, D.C. — Nursing homes across the country are bracing for a sweeping regulatory overhaul that could eliminate dozens of federal requirements operators have long called burdensome and outdated. The Centers for Medicare & Medicaid Services is finalizing a proposed rule that industry sources say could drop any day now, and the scope of potential changes has providers both hopeful and anxious.
The rule, titled “Cutting Administrative Requirements for Excellence in Patient Care,” is currently under review at the White House Office of Management and Budget. According to federal filings, it aims to modernize Conditions of Participation and remove regulations CMS has identified as “obsolete, outdated, and excessively burdensome.”
What Providers Want Gone
Industry groups have submitted extensive wish lists ahead of the rule’s publication. LeadingAge and the American Health Care Association, the sector’s largest advocacy organizations, have called for relief on multiple fronts.
High on the list is the Payroll-Based Journal automatic one-star penalty for missed reporting deadlines. Providers argue the penalty is overly punitive and does not reflect actual quality of care. They are also pushing to expand the percentage of facilities that can earn a Five-Star rating, saying the current thresholds are arbitrarily restrictive.
Other targets include pandemic-era respiratory reporting requirements that many say have outlived their usefulness, along with redundant documentation and survey processes that consume staff hours better spent on residents.
A Mixed Message From Washington
The push for deregulation comes as CMS continues to ramp up enforcement on the reimbursement side. One industry source, speaking on condition of anonymity, called it a paradox: “You’ve got CMS talking about reducing burden while simultaneously making it harder to get paid. It’s a mixed message.”
Will Harris, acting deputy director for the CMS Center for Clinical Standards and Quality, addressed stakeholder concerns during a May call. “We are looking to reduce burden in ways that can still promote and advance quality and safety in those care settings,” he said. “We think that’s incredibly possible.”
What Happens Next
The proposed rule is listed as economically significant in the federal regulatory agenda, meaning it will undergo a public comment period before any changes become final. Providers will have an opportunity to weigh in, though the timeline for implementation remains unclear.
Neil L. Pruitt, Jr., chairman and CEO of PruittHealth, welcomed the administration’s focus. “Healthcare regulations should be measured by whether they improve patient care and outcomes,” he said. “Administrative requirements have grown significantly, consuming resources that could otherwise be directed toward caregivers and patients.”
For now, operators should continue following existing requirements while monitoring developments. Once the rule drops, facilities will need to work with compliance teams and legal advisors to understand what changes actually take effect — and when.
The stakes are high. The nursing home sector has spent years navigating an increasingly complex regulatory environment. Whether this deregulation push delivers real relief or simply shifts the burden elsewhere remains to be seen.
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