CMS Guidelines for Nursing Homes (2026)
The Centers for Medicare and Medicaid Services (CMS) guidelines for nursing homes cover things like infection control standards in nursing homes, staffing mandates, and administrative reporting duties. Staying current with government regulations is challenging for healthcare leaders, given the volume of changes implemented by CMS over the past few years. Our reference guide will help you navigate the most significant changes, and provide updates organized by topic.
Where to Find CMS Guidelines
This section will help you find current and proposed CMS regulations. While it’s impossible to provide a comprehensive list of CMS resources, this overview can help you quickly find the right resource for your facility. You can refer to the CMS announcements page for other general updates and news, such as the annual advance notice (2026) of payment policies.
1. CMS Policy and Memos to States and Regions
The CMS website has a section dedicated to quality, safety, and oversight (QSO) that contains Medicare memos, policies, clarifications, and instructions to state agencies and CMS providers. You can type “nursing homes” in the search feature to narrow down the memos and guidelines impacting your facility.
2. CMS Regulations for Nursing Homes
The CMS QSO webpage also has a subsection on guidance to nursing homes, comprising the current laws, regulations, and requirements affecting long-term care (LTC). This subsection is worth a review as state surveyors will use new CMS guidelines to assess your facility’s compliance with federal requirements. It also contains links to resources that can help you through an initial survey, including instructions for using the long-term care survey process (LTCSP) software involved.
3. Nursing Home Survey and Certification
CMS provides aspiring and current Medicare and Medicaid-certified nursing home providers with links to laws, regulations, and compliance information. Facilities must adhere to the CMS certification process to determine their compliance with federal nursing home regulations. When a facility is found to have poor compliance with nursing home standards, they earn extra attention from CMS and will be listed as a Special Focus Facility (SFF) in this subsection.
4. Skilled Nursing Facility (SNF) Center
This CMS web page provides critical information and updates for SNFs, including:
- Manuals for rules and forms.
- Federal regulations.
- Billing and payment references.
- Educational resources.
- Medicare Learning Network (MLN) newsletter sign-up.
5. Federal Register of Current and Proposed Updates
The Federal Register government website is a valuable resource when looking for CMS rules that have recently passed, proposed rules, or official notices. To access the site, users must request access from the federal government. The Office of the Federal Register (OFR) of the National Archives and Records Administration (NARA) and the U.S. Government Publishing Office (GPO) jointly manage this website, which includes a page devoted to CMS.
CMS Guidelines for Nursing Homes Updates
Multiple changes to CMS regulations have affected nursing homes and long-term care facilities. In terms of staffing-related CMS guidelines, 2025 was a year of deregulation. The requirement for a specific amount of nursing care hours per resident day (HPRD) was rolled back, as was a mandate for 24/7 RN presence. The new federal nursing home regulations focus on acuity-based staffing rather than fixed ratios, and reinstate a prior rule for RN presence of 8 hours a day, 7 days a week. These tables organize and help you keep track of the changes.
1. Clinical Topics
Most new or updated CMS guidelines relate to the relaxation or expiration of infectious-disease-related mandates. For example, the guidelines for enhanced barrier precautions in nursing homes (QSO-24-08-NH) expired. This table summarizes the changes to nursing home standards related to disease management.
Clinical topics are also addressed in our section on administrative CMS guidelines. The 2025 updates cover issues such as schizophrenia diagnoses and the appropriate use of antipsychotic medications.
CMS Guidelines for Nursing Homes: Clinical Topics
| Clinical Laboratory Improvement Amendments of 1988 Post-PHE Guidance (REVISED) | QSO-23-15-CLIA REVISED | Post public health emergency test results | 9/23/25 |
| Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE) (REVISED) | QSO-25-23-ALL | Contains revisions to public health emergency guidelines released in 2023. Focused infection control surveys are no longer a routine part of the nursing home survey process. | 7/30/25 |
| Long-Term Care (LTC) Facility Acute Respiratory Illness Reporting Requirements | QSO-25-11-NH | Electronic reporting information for COVID-19, influenza, and respiratory syncytial virus (RSV) | 12/31/24 |
| Policy and Regulatory Changes to the Omnibus COVID-19 Health Care Staff Vaccination Requirements; Additional Policy and Regulatory Changes to the Requirements LTC Facilities To Provide COVID-19 Vaccine Education and Offer Vaccinations to Residents, Clients, and Staff; Policy and Regulatory Changes to the LTC Facility COVID-19 Testing Requirements | 88 FR 36485
Note:This is located in the Federal Register |
CMS COVID Guidelines for Nursing Homes:
Staff Vaccination; Policy and Regulatory Changes to COVID-19 Vaccine Education, Offering, and Testing |
6/5/23 |
| Guidance for the Expiration of the COVID-19 PHE | QSO-23-13-ALL | PHE Waiver Expiration
Note:This is located in the Federal Register |
5/1/23 |
| Guidance and Survey Process for Reviewing Home Dialysis Services in a Nursing Home | QSO-18-24-ESRD REVISED | Dialysis survey procedure and updates | 3/22/23 |
| Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements | QSO-22-17-ALL | Frequency of Staff Vaccination | 6/14/22 |
2. Emergency Preparedness
Nursing home resident safety remains a priority for healthcare leaders. This section provides information about the CMS long-term care regulations on emergency preparedness.
CMS Guidelines for Nursing Homes: Emergency Preparedness
| Categorical Waiver – Health Care Microgrid Systems (HCMSs) | QSO-23-11-LSC | Emergency Generators for Life Support | 3/31/23 |
| Use of the Fire Safety Evaluation System (FSES), National Fire Protection Association (NFPA) 101A, Guide on Alternative Approaches to Life Safety, 2013 Edition by Health Care Occupancies and Board and Care Occupancies | 17-15-LSC REVISED | Fire Safety Requirements for Recertification | 10/26/22 |
3. Administration
This table organizes the Medicare and Medicaid regulations by administrative topics, including programs, education, staffing, and reports. The CMS minimum staffing requirements for nursing homes that were put in place in 2024 were repealed in 2025. However, many states have minimum staffing laws that nursing homes are required to follow.
CMS Guidelines for Nursing Homes: Administration
| Civil Money Penalty Reinvestment Program (CMPRP) Updates | QSO-25-26-NH | Updates to the reinvestment program, including the application process and funding caps. | 9/29/25 |
| Updates to Nursing Home Care Compare (REVISED) | QSO-25-20-NH REVISED | The Care Compare website rates corporate chains; third survey results dropped from rating calculations; updated antipsychotic medication tracking | 9/10/25 |
| Updates to Nursing Home Care Compare Staffing and Quality Measures (REVISED) | QSO-25-01-NH | Adjustment to the staffing and quality measures used on the Nursing Home Care Compare website | 10/4/24 |
| Nursing Home Data and Care Compare Updates | QSO-24-14-NH | Updates to nursing home guidance for consumers | 7/1/24 |
| Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute | QSO-23-05-NH | Audits related to schizophrenia coding; citations displayed on the Nursing Home Care Compare website | 1/19/23 |
| Revisions to Special Focus Facility (SFF) Program | QSO-23-01-NH CORRECTIONS POSTED 09.27.23 | SFF Updates | 09/27/23 |
| Provider and Supplier Compliance Education Through Quality in Focus (QIF) Training | QSO-23-06-ALL | Quality in Focus training program education updates: new training videos | 1/19/23 |
| Nursing Home Staff Turnover and Weekend Staffing Levels | QSO-22-08-NH | Nurse Turnover and Staffing | 1/7/22 |
4. Surveys
While state surveyors are responsible for following CMS guidelines in conducting their visits, it’s important for you to understand these rules as well. By knowing what the surveyors will evaluate, you can take proactive measures to improve CMS compliance.
CMS Guidelines for Nursing Homes: Surveys
| Revised Long-Term Care (LTC) Surveyor Guidance: Significant revisions to enhance quality and oversight of the LTC survey process (REVISED) | QSO-25-14-NH | Updates to nursing home survey guidance | 3/10/25 |
| Compliance with Residents’ Rights Requirement related to Nursing Home Residents’ Right to Vote | QSO-24-21-NH | Residents’ right to vote; complaints can be filed with state surveyors | 9/27/24 |
| Revised Guidance for Long-Term Care Facility Assessment Requirements | QSO-24-13-NH | Requirements for facility assessments | 6/18/24 |
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Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.