The Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Mission and Priority Document (MPD), which is issued annually to direct and prioritize the agency’s work for the year. The document reflects regulatory changes, budget adjustments, new initiatives, and statutory requirements. It outlines survey, certification, enforcement, and Medicare funding allocations for states, while also providing background information on certified provider and supplier types, as well as accreditation and deeming surveys. Survey activities must be scheduled and conducted according to the priority tier structure set forth in the MPD. These four tiers reflect statutory mandates and program emphasis, with Tier 1 representing the highest priority and Tier 4 representing the lowest.
Survey activity remains central to CMS oversight, and the agency continues to emphasize a tiered survey prioritization structure to ensure resources are focused where they are most needed.
- Under Tier 1, nursing homes must receive a standard recertification survey no later than every 15.9 months, with a national goal of maintaining a 12.9-month average between surveys. States are also required to conduct at least 10 percent of surveys “off-hours,” with at least half of those completed on weekends. Special Focus Facilities (SFFs) must be surveyed at least once every 186 days.
- Tier 2 requires states to maintain the 12.9-month average for nursing home recertification and prioritizes initial certifications if applications have been pending for more than 150 days without a deeming option, or when CMS determines there is an access-to-care issue.
- Tier 3 applies to Medicaid-only nursing homes and other initial certifications not included in Tiers 1 or 2.
For Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), CMS has reinforced similar expectations. These facilities must also adhere to the 15.9-month maximum interval between surveys, with a statewide average of 12.9 months or less. Initial certifications for ICFs/IID fall under Tier 3 and are scheduled based on state priority.
CMS continues to strengthen regulatory compliance and quality improvement efforts. The agency is reinforcing timely survey practices, particularly for Special Focus Facilities.
In addition to survey requirements, CMS discussed new initiatives designed to modernize oversight and address ongoing staffing challenges.
One of the most significant is the continuation of Risk-Based Survey (RBS) testing, a pilot program that focuses resources on higher-performing nursing homes. Facilities that consistently demonstrate strong quality performance may receive a more targeted survey, which is intended to improve efficiency while still ensuring compliance with health and safety standards.
Another major initiative is the Nursing Home Staffing Campaign, supported by a $75 million investment. According to the memo, this campaign aims to raise awareness of career opportunities in nursing homes, provide tuition reimbursement and stipends, and work with states to expand Nurse Aide Training and Competency Evaluation Programs (NATCEPs). By reducing barriers to workforce entry, CMS hopes to expand the pipeline of certified nurse aides available to nursing homes.