LTC Clarified: Weekly News, Insights & Connections

The CMS 5-Star Quality Rating System can feel daunting, and few areas cause more stress than the Health Inspection domain. Health Inspection outcomes are a reflection of how care is delivered every day, and survey performance directly influences your star rating.

Make progress with 2026 goals and wish-list projects on a Proactive Annual Partner Plan which provides an allotment of consulting support hours delivered by seasoned LTC experts at a fraction of the cost of hiring new staff. Support is lead by a designated consultant, and can be provided as a combination of onsite and remote assistance with services billed in 12 flat monthly installments. Plans start as low as 8 hours per month with facility customized work plans that provide just-right support for survey-readiness, QM improvement, key clinical programs, reimbursement accuracy and crisis management. Add the Proactive team to your roster and achieve the outcomes you’ve been working toward! Contact us to learn more.

Q: A resident reports that a staff member has mistreated them. What steps should be taken?

JANUARY: Check out these upcoming January webinars!

FEBRUARY: Check out these upcoming February webinars!

This advanced workshop is designed for established team members seeking to advance insights and depth of knowledge into driving MDS accuracy, Five Star QMs, SNF QRP and VBP performance. Curriculum moves beyond the basics to emphasizes real-world application, regulatory updates, and strategies to optimize quality outcomes and financial performance. Learn more and register here.

In the News

Reduced Survey Expectations Due to Government Shutdown

CMS is adjusting the evaluation of several FY26 SPSS measures in recognition of the Federal government shutdown that occurred from October 1, 2025 through November 12, 2025. Measures directly impacted by shutdown guidance (refer to QSO-26-01-ALL Revised) limiting SAs’ ability to conduct certain survey and certification work will have an exception applied commensurate with the approximate time period affected, approximately 20% of the FY. These exceptions will only be applied FY26 and will not carry over into future years. Access the full memo here.

January 2026 Five Star Users’ Guide Revisions

Effective with the January 2026 refresh, the long-stay antipsychotic medication quality measure is replaced with a quality measure that incorporates Medicare and Medicaid claims data and Medicare Advantage encounter data as a supplement to MDS data. Scoring cut points are set to allocate providers into 10 equal deciles based on the distribution of providers' performance. Please refer to CMS Memorandum QSO-25-20-NH REVISED for more information. Access the Five Star Users' Guide January 2026 (PDF).

Source: cms.gov/medicare/health-safety-standards/certification-compliance/five-star-quality-rating-system

SNF QRP Provider Preview Reports Available

The SNF Provider Preview Reports have been updated and are now available. Providers have until February 14, 2026, to review their performance data which will be published on the compare tool with the April 2026 refresh. Data is based on assessment data submitted from Q3-2024 through Q2-2025. Only updates/corrections to the underlying assessment data before the final data submission deadline will be reflected in the publicly reported data, but providers can request a CMS review of their data during the preview period if they believe the displayed quality measure scores within their Provider Preview Reports are inaccurate. To access the reports: Log into iQIES using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password. From the Reports menu, select My Reports. rom the My Reports page, locate the SNF Provider Preview Reports folder. Select the SNF Provider Preview Reports link to open the folder. Select the desired SNF Provider Preview Report name link and the report will display. 

CMS FY2025 Improper Payments

The estimated improper payment rates for CMS' programs in Fiscal Year (FY) 2025 are:

The Medicare Fee-for-Service (FFS) estimated improper payment rate was 6.55%, or $28.83 billion, compared to the FY 2024 reported rate of 7.66%, or $31.70 billion. The FY 2025 estimate marks the ninth consecutive year this figure has been below the 10%threshold for compliance established by improper payment statutory requirements. ^[1] 

• The Medicare Part C estimated improper payment rate was 6.09%, or $23.67 billion, compared to the FY 2024 reported rate of 5.61%, or $19.07 billion. 
• The Medicare Part D estimated improper payment rate was 4.00%, or $4.23 billion, compared to the FY 2024 reported rate of 3.70%, or $3.58 billion.
• The Medicaid estimated improper payment rate (comprised of the past three cycles of approximately 17 state per cycle from reviews in 2023, 2024, and 2025) was 6.12%, or $37.39 billion, compared to the FY 2024 reported rate of 5.09%, or $31.10 billion. Of the FY 2025 Medicaid improper payments, 77.17% were the result of insufficient documentation, which is generally not indicative of fraud or abuse. 

More information on CMS' Improper Payments Measurement Programs can be 

found here. Access the HHS Agency Financial Report here.

CDC Nursing Home Data Dashboard

Updates to the Nursing Home Data Dashboard were made January 15, 2026 including information on vaccination coverage, Hospitalization Rates, and Case Rates among other information.