CMS Issues New and Revamped Standards for State Nursing Home Surveyors for 2025

On Wednesday, the Centers for Medicare and Medicaid Services (CMS) released plans to update the State Performance Standards System (SPSS) for the 2025 fiscal year. This will involve eliminating two measures from the previous year, introducing a new one, and revamping several others.

A new addition to the SPSS, which is the federal agency’s rubric for grading the network of State Survey Agencies, is a measure under the section of Survey and Intake Quality: the Nursing Home Recertification Survey Deficiency Citation and Tasks Investigated. This measure will assess the frequency and type of nursing home deficiencies and the completion of mandatory or triggered tasks on recertification surveys. 

Moreover, CMS has reintroduced some measures with updates in this same domain. These measures will allow CMS to compare State Survey Agency citations against findings from federal comparative surveys, ensuring that assessments are aligned with national standards.

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The federal agency is also retiring the data submission measure and measures on the timeliness of upload of recertification surveys, it noted in a memo. This adjustment stems from the recent implementation of the Internet Quality Improvement and Evaluation System (iQIES), which is expected to streamline survey uploads and improve data integrity.

Key changes

The FY25 SPSS consists of 13 measures in three domains – and many of these remain the same. The measures cover a range of areas, and particularly aim to improve the timeliness of surveys, which operators have complained have caused hurdles ranging from problems during acquisition of distressed facilities to financial loss to misinformation during legal proceedings.

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In the Survey and Intake Quality category, through the new measure, CMS will evaluate the frequency and types of deficiencies in nursing homes, as well as the completion of required tasks during recertification surveys. This evaluation will be presented as a composite score that incorporates several factors, including the number of deficiencies per 1,000 beds, the percentage of deficiency-free surveys, and the identification rates of various severity levels. It will also assess how many surveys failed to investigate mandatory or triggered tasks.

Among those reintroduced in the Survey and Intake Quality domain is an assessment of whether the survey practices comply with federal standards using focused concern surveys.

“CMS will assess whether State Survey Agency nursing home compliance, recertification, and revisits are being conducted in compliance with Federal standards, protocols, forms, methods, and procedures specified by CMS using the Federal Monitoring Survey (FMS) Focus Concern Surveys (FCS) results,” the agency said in the memo.

The Survey and Intake Process category has no changes. Here, for surveys of SFFs, CMS will continue to evaluate the frequency of recertification surveys, requiring State Survey Agencies to conduct these surveys at least once every 186 days. Agencies must also select new SFFs within 21 days after a facility graduates or is terminated from the program.

Meanwhile, the Immediate Jeopardy (IJ) template will also be used across various provider types, including nursing homes, to ensure timely and consistent handling of critical issues. CMS will track the number of IJ complaints and facility-reported incidents that are overdue for investigation, aiming for a 35% reduction in these overdue cases within the fiscal year.

In the third domain that CMS lists as the Noncompliance Resolution, there are also no changes. Through this category, CMS will continue to ensure that nursing home recertification health surveys are conducted within a maximum time interval of 15.9 months.

Important dates

The evaluation period for the FY25 SPSS measures spans from October 1, 2024, to September 30, 2025. Key dates include the availability of FY25 SPSS results for State Survey Agency review and reconsideration on January 16, 2026, and the finalization of results by February 27, 2026. State agencies will have until March 13, 2026, to submit corrective action plans if they fail to meet specific measures.

The federal agency noted that it will work with State Survey Agencies to address their performance as assessed by the SPSS measures during this fiscal year. Questions or feedback related to the SPSS can be directed to [email protected].

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