Baltimore, Maryland — A new federal proposal would force nursing homes to track and submit detailed clinical data on every resident receiving covered skilled care — regardless of who’s paying the bill. For an industry already drowning in compliance requirements, that’s a significant expansion of paperwork, and CMS’s own regulatory analysis estimates the added burden will run into the millions of hours.
The requirement is buried inside the proposed rule for the Skilled Nursing Facility Prospective Payment System for fiscal year 2027, which CMS published in the Federal Register on Tuesday. On the surface, the rule is mostly about the 2.4% Medicare payment update — but the quality reporting changes are drawing attention from compliance officers and administrators who have spent months parsing the details.
Currently, nursing homes report Minimum Data Set (MDS) assessments primarily for Medicare residents. Under the new proposal, that would change: facilities would need to submit MDS data on all SNF residents receiving covered skilled care, no matter their payer source. That means Medicaid residents, private pay patients, and others would all be pulled into the reporting net.
CMS argues the move aligns the SNF Quality Reporting Program with how other post-acute care settings already operate and will improve the completeness of data used for public quality reporting on Medicare’s Care Compare tool. More complete data, the agency contends, means better information for consumers and families choosing care.
The compliance math is daunting
For facilities, the math tells a different story. Industry analysts who reviewed CMS’s regulatory impact estimates say the new MDS submission requirement alone could add well over a million hours of annual reporting work across the country’s approximately 15,000 nursing homes. That burden falls disproportionately on smaller operators and rural facilities with limited administrative staff.
The same proposed rule also makes changes to how quickly facilities must submit MDS data. CMS wants to tighten the submission window from 4.5 months down to no later than the 15th day of the second month after the end of each calendar quarter — a deadline that would take effect starting with the FY 2029 reporting cycle. The goal is to reduce the lag in public reporting by up to three months, giving families more timely quality information.
Two other changes in the rule are easier to swallow: CMS is proposing to remove both COVID-19 vaccination measures from the quality reporting program beginning with FY 2028, acknowledging that the pandemic-era metrics have run their course.
More questions than answers
CMS is also asking for public comment on potential future measures, including a possible requirement around advance care planning. The agency wants to know how it might capture whether residents have documented their care preferences before a crisis — a measure that supporters say is long overdue and critics worry could add yet another compliance layer.
The rule also includes a request for information on updating the Patient Driven Payment Model to address case mix upcoding — a practice the agency believes has cost Medicare hundreds of millions of dollars. That topic is addressed separately in the proposed rule and has drawn its own industry response. (Industry analysts were already weighing in on the PDPM implications when CMS first released the payment proposal earlier this month.)
Public comments on the proposed rule are due by June 1, 2026. Providers are encouraged to submit responses through regulations.gov, referencing file code CMS-1843-P.
