CMS Releases FY26 State Survey Agency Performance Standards

On January 13, 2026, the Centers for Medicare and Medicaid Services (CMS) issued its annual guidance related to State Performance Standards, the assessment by which State Survey Agency (SA) performance is measured. The FY26 guidance has been updated to account for the Federal government shutdown.

State Survey Agencies are scored as “met,” partially met,” “not met,” “requires research,” or “N/A.”

All measures that are “not met” require the State Agency to develop and implement a corrective action plan. A corrective action plan is also required if a SA receives a “Partially Met” score in back-to-back FYs.

Focused Assessment Areas

Providers should be aware that the FY26 performance domains are all about survey:

• Survey and Intake Process
• Survey and Intake Quality
• Noncompliance Resolution

While this shouldn’t be a surprise since the agencies being evaluated are State Survey Agencies, it’s important to remember that this puts the pressure on survey staff to perform up to expectations – but helps providers understand where priorities will lie.

Survey and Intake Process Measures

For post-acute providers, the following measures are relevant. These measures have been in place, but if you haven’t seen them before or need a reminder, we’ll review the expectations.

SFFs must have one standard Health recertification survey at least once every 186 calendar days.

Once a SFF is either terminated or graduates, another SFF must be selected within 21 calendar days as a replacement, so all SFF slots are filled. The selection date is the date that the State Agency sends its notification letter to the new SFF.  CMS has indicated in this document that State Survey Agencies should send graduation letters ASAP, but not later than five business days after a SFF has returned to substantial compliance, meets graduation criteria and CMS has provided approval for the SFF graduation.

S1 – Exceptions to Address the Federal Government Shutdown

• All Special Focus Facilities (SFFs) that were due to be surveyed during Q126 (October 1, 2025-December 31, 2025) must be surveyed by March 31, 2026.
• SFFs that were eligible to graduate between September 15, 2025 and November 15, 2025 will not have the 21-calendar day replacement timeframe evaluated by CMS.

Key timeframes that must be met:

• Nursing Home Complaints and Facility-Reported Incidents (FRIs) with inadequate resident protection: Three business days from the intake received to survey start date
• Facility-Reported Incidents with potentially adequate resident protection: Seven business days from the intake received to the survey start date. If a nursing home complaint or FRI is initially received after 5PM local time, on a weekend or on a Federal holiday, then the next business day is considered the start date for the purposes of evaluating this measure.

S6 – Adjustment to Address the Federal Government Shutdown

CMS is reducing the requirements for “met” and “partially met” for all of the thresholds for S6 due to the government shutdown. The criteria now stand at:

• At least 8% of recertifications surveys begin off-hours. Off-hours include those that start on weekends (Saturday or Sunday), Federal holidays, early morning (pre-8AM) or evening (post-6PM)
• At least 40% of off-hour surveys must be started on weekends. The expected number of off-hour surveys is 10% of all recertification surveys in a Fiscal Year.
• At least 70% of those off-hour weekend surveys must be conducted at facilities where potential staffing issues have been identified. This includes facilities that have been identified by the Payroll-Based Journal (PBJ) as having low weekend staffing and/or a high number of days with no RN. This will be measured through the number of expected off-hour surveys, which is 5% of all recertification surveys in a FY.

Health recertification surveys must be conducted no later than 15.9 months after the last day of the previous health recertification survey. Interestingly, per CMS, SAs are still resolving overdue recertification surveys from the COVID-19 PHE, so states will not be measured on whether they have a statewide average of 12.9 months between consecutive surveys or not.

S7 – Adjustment to Address the Federal Government Shutdown

S7 thresholds are also being lowered due to the shutdown.

Survey and Intake Quality

The second performance domain is Survey and Intake Quality. Relevant measures include:

The target for State Survey Agencies is that 80% of more of the deficiencies that were identified on Federal comparative surveys that have a scope and severity of more than minimal harm or greater were also identified by the SA and at the same or higher scope and severity. If you’ve had a Federal comparative survey, you know that’s probably not likely.

CMS notes that if an IDR/IIDR is upheld, it indicates that the State Survey Agency didn’t provide sufficient supporting evidence for the existence of noncompliance or for the scope and severity of a deficiency. SAs are expected to have less than 40% of their tags that are reviewed as part of the IDR/IIDR process be overturned. No more than 5% of surveys where an IDR/IIDR has been requested between FY24 and FY26 may remain in “requested” status beyond the 60-day competition timeframe.

Those types and frequencies include:

• % deficiency-free surveys
• % surveys with Harm (scope and severity of G, H or I) identified
• % surveys with Immediate Jeopardy (scope and severity of J, K or L) identified
• % surveys where 1 or more Mandatory Tasks were not investigated
• % surveys where 1 or more Triggered Tasks were not identified
• # of deficiencies per 1000 beds
• State Agencies do not need to develop corrective action plans for this measure.

A new scoring category was added for the Q4 measure in FY25, “Requires Research.” If the measure value for Q4 is less than the required threshold, then it will receive this classification. States that receive this classification will need to do more review work to identify why it received a particular score on this measure.

Noncompliance Resolution

The third performance domain is noncompliance resolution and includes only one measure.

Required timeframes for nursing homes: 60 calendar days or less after the survey exit date for a survey where deficiencies at a scope and severity of F with Standard Quality of Care (SQC) or higher have been identified.

For home health agencies and other providers, on-site revisits should be 45 calendar days or less after the survey date for surveys where condition-level deficiencies have been cited.

N1- Adjustment to Address the Federal Government Shutdown

Nursing home health surveys with an exit date during the shutdown where deficiencies were cited at a scope and severity of F with substandard quality of care and no deficiencies cited at a scope and severity of G or higher will not be measured in FY26.

Home health agency surveys with an exit date during the shutdown where condition-level deficiencies were cited without immediate jeopardy will be excluded from the measure in FY26.

Performance Measures Being Retired

Each year, CMS reviews performance measures for State Agencies and can add/ remove as needed. Three of the previous year’s measures have been retired:

• Use of the Immediate Jeopardy (IJ) template, since a high volume of SAs (90%) met the threshold for using the template (80% of the time for IJ tags)
• IJ intakes overdue for investigation due to 88.5% of State Survey Agencies having less than two overdue nursing home IJ intakes (and the same numbers for other provider types)
• Focused concern surveys, since these were discontinued by CMS in FY2025

If all this wasn’t enough information for you, you can view CMS Admin-Info: 26-02-ALL, “Fiscal Year 2026 FY26 State Performance Standards System (SPSS) Guidance” here. If you need assistance preparing for survey or post-survey, CMSCG can help. Contact us to learn more about our services for nursing homes, home health agencies and other providers.