CMS Guidelines for Nursing Homes: 2023-2024

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Written by Diana Campion, MSN, APRN, ANP-C Education Development Nurse, Content Writer, IntelyCare
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Reviewed by Katherine Zheng, PhD, BSN Content Writer, IntelyCare
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Staying current with government regulations is challenging for healthcare leaders, given the volume of changes implemented by the Centers for Medicare and Medicaid Services (CMS) over the past few years. Our CMS Guidelines for Nursing Homes: 2023 – 2024 reference helps you navigate the most significant changes by showing you where to find them and providing updated regulation tables broken down 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 will provide a helpful overview so you can quickly find the right resource for your facility.

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 Laws and Regulations Guidance to 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 updated CMS guidelines for nursing homes (2023 – 2024) to assess your facility’s compliance with federal requirements. It also contains an overview of the final rule and additional resources.

3. Nursing Home Survey and Certification

This CMS webpage provides aspiring and current Medicare and Medicaid-certified nursing home providers with links to laws, regulations, and compliance information. Nursing homes must adhere to the CMS certification process to determine their compliance with federal regulations.

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 rules
  • Educational resources
  • Medicare Learning Center (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. The Office of the Federal Register (OFR) of the National Archives and Records Administration (NARA) and the U.S. Government Publishing Office (GPO) jointly manages this website, which includes a page devoted to CMS.

CMS Guidelines for Nursing Homes Updates

Multiple changes to CMS regulations have affected nursing homes from the start of the pandemic to the end of the COVID-19 Public Health Emergency (PHE). These tables organize and help you keep track of changes from 2023-2024.

1. Clinical Topics

Most new or updated CMS guidelines for nursing homes relate to COVID-19. This table summarizes those regulations (including one for nursing home dialysis services).

CMS Guidelines for Nursing Homes 2023–2024: Clinical Topics

Memo Title Link Topic Posting Date
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: On Federal Register, not yet posted on CMS Memorandums

CMS COVID Guidelines for Nursing Homes:

Staff Vaccination; Policy and Regulatory Changes to COVID-19 Vaccine Education, Offering, and Testing


Effective: 8/04/2023

Clinical Laboratory Improvement Amendments of 1988 Post-PHE Guidance QSO-23-15-CLIA Post-PHE Test Results 5/11/23
Nursing Home Visitation – COVID-19 (REVISED) QSO-20-39-NH REVISED 05.08.2023 Visitation 5/8/23
Guidance for the Expiration of the COVID-19 PHE QSO-23-13-ALL PHE Waiver Expiration 5/1/23
Strengthened Enhanced Enforcement for Infection Control Deficiencies and Quality Improvement Activities in Nursing Homes QSO-23-10-NH Infection Control and Quality Improvement 3/30/23
The Importance of Timely Use of COVID-19 Therapeutics QSO-23-03-All Treatment 11/22/22
Revised Guidance for Staff Vaccination Requirements QSO-23-02-ALL Staff Vaccination 10/26/22
Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Related to LTC Facility Testing Requirements QSO-20-38-NH REVISED 09/23/2022 Testing 9/23/22
Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers REVISED QSO-22-15-NH & NLTC & LSC REVISED Termination of Specified Waivers 8/29/22
Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements QSO-22-17-ALL Frequency of Staff Vaccination 6/14/22
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

2. Emergency Preparedness

Nursing home resident safety remains a top priority for CMS and healthcare leaders. This section provides updated government guidance and nursing home regulations on emergency preparedness.

CMS Guidelines for Nursing Homes 2023–2024: Emergency Preparedness

Memo Title Link Topic Posting Date
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
Guidance related to Emergency Preparedness- Exercise Exemption based on A Facility’s Activation of their Emergency Plan QSO-20-41-ALL REVISED 05.26.2022 Emergency Preparedness Requirements and Expectations 5/26/22

3. Administration

This table organizes the Medicare and Medicaid regulations by administrative topics, including programs, education, staffing, and reports. CMS conducted a study to help establish new minimum staffing requirements, but they still need to submit their proposals.

CMS Guidelines for Nursing Homes 2023–2024: Administration

Memo Title Link Topic Posting Date
Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Codsuband Posting Citations Under Dispute QSO-23-05-NH Five Star Ratings Program; Citations Under Dispute 1/18/23
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 QIF Education Updates 1/19/23
Nursing Home Staff Turnover and Weekend Staffing Levels QSO-22-08-NH Nurse Turnover and Staffing 1/7/22
FY 2021 Report to Congress (RTC): Review of Medicare’s Program Oversight of Accrediting Organizations and the Clinical Laboratory Improvement Amendments of 1988 Validation Program QSO-23-14-AO/CLIA Mandatory Annual RTC for 2021 (published in 2023) 5/10/23

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 2023–2024: Surveys

Memo Title Link Topic Posting Date
Revisions to Hospice-Appendix M of the State Operations Manual and the Hospice Basic Surveyor Training QSO-23-08-HOSPICE Hospice Surveyor Training 1/27/23
Revisions to Surveyor Guidance for Phases 2 & 3, Arbitration Agreement Requirements, Investigating Complaints & Facility Reported Incidents, and the Psychosocial Outcome Severity Guide QSO-22-19-NH Surveyor Training & Guidance 6/29/22
State Obligations to Survey to the Entirety of Medicare and Medicaid Health and Safety Requirements under the 1864 Agreement QSO-22-12-ALL CMS Budget Adjustment to Non-Compliance of State Surveys 2/9/22

Need to Be Alerted to Any Changes to CMS Guidelines for Nursing Homes (2023 – 2024)?

As a healthcare leader in long-term care, you manage many responsibilities, including staying up to date on Medicare guidelines and other industry changes. Sign-up for the IntelyCare Newsletter, which helps level-load the heaviest part of this responsibility by alerting you to significant changes and trends in nursing home care.

Article updated for February 2024.