In several recent communications, the Centers for Medicare & Medicaid Services (CMS) has emphasized its focus on less predictable survey cycles to keep providers on their toes. Some of this guidance is new, and some of it isn’t, but it can be confusing to get through. Let’s review some of the key guidance issued in the month of January alone.
Revisions to the FY26 State Performance Standards System (SPSS) Guidance
On January 13, 2026, CMS issued an Admin Memo, “Fiscal Year 2026 (FY26) State Performance Standards System (SPSS) Guidance” (Admin Info: 26-02-ALL). A couple survey-timing related items are part of the evaluation for State Agencies:
- Special Focus Facilities (SFFs) must have one standard health recertification survey at least once every 186 calendar days (more on SFFs below)
- At least 8% of a State’s recertification surveys begin off-hours. Off-hours surveys include those which start on weekends, Federal holidays, early morning (prior to 8AM) or evenings (after 6PM)
- 40% of the off-hour surveys must start on weekends.
- 70% or more of the off-hour weekend surveys must be at facilities where potential staffing issues have been identified via the PBJ.
- Health recertification surveys must be conducted no later than 15.9 months after the last day of the prior health recertification survey. Since surveyors are still addressing overdue recertification surveys due to the COVID-19 PHE, the usual measure of whether a State has a statewide average of 12.9 months between surveys will not be assessed for FY26.
Revisions to the SFF Program
On January, 28, 2026, CMS issued a revised QSO Memo QSO-23-01-NH, “Revisions to the Special Focus Facility (SFF Program). This Memo, originally released in November 2022 and previously revised in September 2023, discusses the Agency’s actions to strengthen the Special Focus Facility Program. Nursing homes which have been designated as SFFs are supposed to be surveyed every 6 months; the revised language indicates that oversight will be strengthened by “reducing survey predictability.”
The Memo states that SFFs will have a standard health survey “at least once every six months” and “no less than twice annually.” For Life Safety Code (LSC) and Emergency Preparedness (EP) surveys, the established frequency will be “at least annually” – unless the State or CMS feels this is not sufficient.
Another fun little nugget of info added to this Memo: States are supposed to consider the prevalence of falls when selected an SFF. This indicates a departure from the previous version of this Memo which indicated that States should consider the facility’s staffing levels when selecting a candidate to be added to the SFF list.
Revisions to State Operations Manual (SOM) Chapter 7
In a QSO Memo released January 30, 2026, CMS issued a new QSO Memo, “Revisions to State Operations Manual (SOM) Chapters 5 and 7.”
CMSCG discussed these changes with McKnight’s Long-Term Care News. Check out this recent article: “Up next for nursing home surveys: more after-hours inspections, consistent team staffing.”
New language incorporated into Chapter 7:
- Standard Survey Interval for SFFs – “surveyed no less than once every six months.”
- Unannounced Surveys – After entrance for all standard health surveys, survey teams are expected to remain in the facility for a minimum of five consecutive hours. Specifically, survey teams are not supposed to enter, conduct an entrance conference and come back the following day. Surveyors are also not supposed to start a survey on a Friday and enter Monday since surveys are expected to be conducted on consecutive days.
- Variance in Survey Timing – The month in which a survey starts should not be the same month as the previous standard survey, if possible. State and Federal holiday surveys count towards the off-hour surveys.
There are several items/percentages included in the Variance in Survey Timing revisions that don’t match the adjusted numbers for SPSS for FY 2026, although the same information is included in Chapter 7 now. (View this CMSCG Blog post, “CMS Releases FY26 State Survey Agency Performance Standards” for full details on how your State’s surveyors are being evaluated and the adjusted percentages):
- At least 10% of standard health surveys should be conducted as off-hours surveys. As indicated earlier in this post, those numbers have been reduced for this FY (down to 8% vs. 10%)
- There is also a difference in the SPSS guidance and what’s been added to Chapter 7 as far as timing for off-hours surveys. The revision to Chapter 7 indicates prior to 6AM and after 5PM for off-hours, but the SPSS indicates before 8AM and after 6PM. There will likely be a clarification to one of these documents.
- Chapter 7’s revisions now indicate that 50% of the 10% of 0ff-hours surveys must begin on a weekend.
So, all that said, is there a “new” push for more unpredictable surveys, including off-hours surveys? For Special Focus Facilities, this will likely be a change. For other providers, the same triggers and similar performance standards remain in place as part of the evaluation process for State Agencies (SAs). If you read the list of potential concerns which surveyors may see “more of” at night in your facility or if you’ve had a lot of complaints/reported events in one or more of those areas, then you may need to consider posting a night watchman (especially for staffing concerns!). However, it’s likely your chances are about the same as they have been that you’ll have surveyors on your doorstep off-hours. Wouldn’t it be interesting to see the results of a recertification survey that started on a Federal holiday?
