The American Health Care Association (AHCA)’s Better Way agenda is based on the principle that America’s aging population unequivocally deserves high quality care. In order to deliver that care, providers need an efficient, effective, transparent, and accountable regulatory system that prioritizes residents and their caregivers. Better Way begins with the premise that oversight is necessary—and that it must be rational.
Reform takes time, but recent Centers for Medicare and Medicaid Services (CMS) updates show that policymakers are listening to the concerns of long term care providers across the country. Recent rule changes address longstanding inefficiencies and restrictive policies, helping skilled nursing facilities (SNFs) redirect their focus from untangling bureaucratic red tape to caring for their residents. From faster dispute resolution to more accessible civil money penalty funds, here’s what’s changed and what those changes mean for AHCA members.
Faster, More Transparent Dispute Resolution
CMS’s Informal Dispute Resolution (IDR) process gives facilities the right to appeal citations. For many providers, their appeal has been complicated by the time it takes regulators to complete the process. Some AHCA members have waited close to a year for a decision, all the while facing reputational damage due to the deficiency cited on their record. In addition, they have often received decisions with no clear explanation, leaving them in the dark about the full picture of the alleged deficiency.
This is why the Better Way agenda advocated for IDRs to require timely response from CMS and state health departments, with a written rationale for the regulator’s decision. New CMS guidance, which took effect on April 30, 2026, provides for just that: a decision completed within 60 days of the facility’s request, with a written explanation of the reviewer’s conclusions.
“We’re encouraged that they provide clarity on that process,” said Holly Harmon, AHCA/NCAL’s senior vice president of quality, regulatory, and clinical services. “We appreciate and advocated for that because understanding the rationale behind a decision is inherent to quality improvement so the right interventions can be applied.”
More Efficient Reviews
In another helpful update, CMS adjusted its guidance regarding offsite reviews of cited deficiencies, also known as desk reviews. As providers know, when surveyors issue citations to a facility, the facility responds by submitting a plan of correction, after which the surveyor returns to ensure compliance. However, many deficiencies don’t necessarily require onsite observation to ensure compliance, and because of state agencies’ backlogs, those return visits often happen only after considerable delays.
It was with these backlogs in mind that AHCA advocated for CMS to allow desk reviews of some deficiencies—a change that would help increase government efficiency while speeding up the review process for providers. In guidance that also took effect on April 30, 2026, CMS allows offsite reviews for less serious deficiencies—D, E, and F without substandard quality of care—and for those that simply don’t require direct observation. “This update helps everyone use their resources more effectively,” said Harmon. “It means that state surveyors can be more effective in performing onsite or offsite follow-up, where indicated.”
The updates also provide clearer guidance on noncompliance survey timelines. In the past, agency backlogs could result in overlapping survey cycles, with facilities correcting alleged deficiencies only to have new complaint investigations extending the enforcement cycle—even if the facility returned to compliance after the earlier citations. The new framework, for which AHCA advocated, closes the original survey cycle and starts a new one, provided certain conditions are met.
CMS also updated the Nursing Home Compare Health Inspection Rating, providing a more accurate and timely picture for consumers. Previously, CMS used a facility’s three most recent standard surveys to calculate its star rating. However, starting in July 2025, as a result of ongoing backlogs, the tool refined the calculation to incorporate only the two most recent surveys.
Reevaluating Revalidation
In December 2025, CMS also announced the indefinite suspension of its January 1, 2026, deadline for the mandatory off-cycle SNF provider enrollment revalidation process. Ownership disclosures are nothing new for nursing homes; however, new reporting requirements drastically expanded the amount of information providers needed to gather, including information from unrelated third parties that have no ownership stake. Meanwhile, the off-cycle revalidation process was a first-time attempt to revalidate all 15,000 nursing homes at the exact same time. As a result, providers and CMS’s data reporting systems were overwhelmed, resulting in the need to suspend the deadline to submit the disclosures.
AHCA was a champion of relaying the unrealistic deadline to CMS. “We appreciate CMS’s recognition of the significant challenges that providers faced throughout this unprecedented and extensive revalidation process, and we are grateful they are offering indefinite relief,” said John Kane, senior vice president of reimbursement policy at AHCA/NCAL. “Ultimately, this protects continuity of care for our residents.” Failing to properly submit their revalidation paperwork by the deadline threatened suspension of the facility from the Medicare and Medicaid programs.
Kane argued that there needs to be a sustainable balance between transparency and administrative burden, something AHCA will continue to advocate to policymakers. “We look forward to continuing to work with CMS on ways we can streamline reporting and focus on the information that is meaningful to residents, families, and stakeholders.”
While the deadline is suspended, the revalidation process remains as many nursing homes continue to submit their paperwork, and CMS continues to share this information publicly once processed.
CMP Reinvestment Updates
A vital update to the Civil Money Penalty (CMP) Reinvestment Program was implemented in late 2025, after years of advocacy by AHCA. As Hawley Hunt, AHCA/NCAL senior director, regulatory and quality services, explained in the Spring issue of Provider, the program is designed to let SNFs and other stakeholders access CMP funds for various quality-improvement projects. In 2023, however, CMS removed several reinvestment options, making the program too restrictive for many providers.
Thanks to CMS’s updates last year, providers can now use CMP funds for a wider variety of purposes, including technological investments, workforce development, and behavioral health services. In addition, whereas the application process used to be prohibitively complex—with different versions for providers in different states—CMS has now improved it to a single form. “We’re grateful to CMS for responding to our concerns about the program,” Harmon said. “We believe that these changes are significant to increase access and use of the available CMP funds in support of quality improvement in nursing homes.”
Roadmap for the Future
Another encouraging development is the new strategic roadmap released by CMS’s Center for Clinical Standards and Quality (CCSQ) in early March 2026. The plan lays out five strategic goals that CMS CCSQ will advance over the coming years: Prevention, Quality and Safety, Coverage Innovation, Data and Technology, and Burden Reduction. It also describes programs that align closely with AHCA’s Better Way proposals: risk-based surveys, an accrediting organization pilot, streamlining outdated regulations, simplifying redundant data systems, and updated guidance for evidence-based nutrition standards.
“We’re encouraged to see a number of changes in the CCSQ roadmap that we believe could bring holistic reform and drive better results and quality,” said Harmon. “CMS specifically states that everyone deserves care that is safe, reliable, and high quality, and AHCA fully agrees.”
As these updates show, policymakers and providers share a common goal: building a more efficient, rational oversight system that will improve the health and safety of America’s aging population. That objective is at the heart of AHCA’s Better Way agenda, and it will shape the organization’s advocacy in the years to come.
Steve Manning is a journalist based in New York City.