CMS CARE Proposal for Nursing Homes: Less Paperwork Does Not Mean Less Accountability

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The Centers for Medicare & Medicaid Services (CMS) has proposed a broad set of regulatory changes intended to reduce administrative burden across healthcare. For nursing homes, the proposal could eliminate or simplify several reporting, documentation and notification requirements.

The most important point for long-term care leaders is also the simplest: this is a proposed rule. It is not yet effective, and current requirements remain in place.

CMS published the Cutting Administrative Requirements for Excellence in Patient Care, or CARE, proposed rule on November 10, 2026. The proposal is identified as CMS-3484-P and appears at 91 Federal Register 72634. Public comments are due January 11, 2027.

If finalized, the rule could reduce administrative work for nursing homes. It would not, however, remove the need to maintain reliable compliance evidence, complete facility assessments, manage workforce requirements or prepare for surveys.

What is the CMS CARE proposed rule?

CMS reviewed the Conditions of Participation, Conditions for Coverage and Requirements for Participation across 21 provider and supplier types. The agency identified requirements it considers outdated, duplicative or excessively burdensome.

CMS estimates that the entire proposal would save approximately $320 million annually and return more than 3.26 million staff hours to providers. The agency estimates that the long-term care provisions alone could produce approximately $142.6 million in annual savings.

For nursing homes, the proposal focuses on infection-control reporting, COVID-19 vaccination documentation, emergency-transfer notices, facility assessments, physical-environment standards and Medicaid payment-transparency reporting.

What could change for nursing homes?

1. Weekly respiratory-illness reporting could end

CMS proposes eliminating the ongoing weekly reporting of acute respiratory-illness data by long-term care facilities. Certain reporting requirements would remain available during a future public health emergency declared by the Secretary of Health and Human Services.

This could reduce repetitive reporting outside an emergency. It would not eliminate a facility's broader infection-prevention, surveillance, documentation or Quality Assurance and Performance Improvement responsibilities.

2. Staff COVID-19 vaccination documentation could be reduced

The proposal would remove the federal requirements for nursing homes to educate staff about COVID-19 vaccine benefits and risks, offer the vaccine and document those actions.

CMS would streamline, rather than eliminate, the corresponding requirements for residents. Facilities would also need to consider any state, local, employment or internal policy requirements that continue to apply.

3. Some emergency-transfer notices to the ombudsman could be eliminated

CMS proposes removing the requirement to provide the state long-term care ombudsman with notice when a resident is transferred for emergency care.

The proposal is narrowly focused on emergency transfers. Other resident transfer and discharge protections—including notice and appeal requirements where applicable—would continue.

4. The facility-assessment participation requirement could be narrowed

CMS proposes removing the requirement for the active involvement of representatives of direct-care staff in the facility assessment. The agency would retain the remainder of the facility-assessment requirements.

This distinction matters. CMS is not proposing to eliminate the facility assessment. Nursing homes would still need to conduct and document a facility-wide assessment of the resident population and the staffing, competencies, services, equipment and other resources necessary to provide appropriate care.

CMS is also asking for public input on technological tools that could help facilities complete their assessments more efficiently without reducing their quality or usefulness.

For long-term care leaders, this is an important signal: technology is increasingly being considered not only as a way to store documents, but also as a way to organize responsibilities, verify evidence and support a repeatable compliance process.

5. Existing facilities could receive protection during ownership changes

The proposal would prevent certain existing facilities from becoming subject to newer room-occupancy and bathroom standards solely because of a change of ownership or a lapse and restoration of certification.

This could remove a costly barrier during transactions or operational transitions. It would not eliminate applicable life-safety, accessibility, state-licensing or resident-safety requirements.

6. Life-safety and emergency-power standards could be modernized

CMS proposes adopting the 2024 editions of the National Fire Protection Association Life Safety Code and Health Care Facilities Code, with limited exceptions. It also proposes adopting the 2022 emergency and standby power standard and allowing additional emergency-power sources.

Although the proposal is intended to modernize requirements and create flexibility, facilities would still need to determine how final code changes affect inspections, testing, maintenance records, emergency-power documentation and survey preparation.

7. Medicaid compensation reporting could be rescinded

CMS proposes rescinding requirements for states to report, at the facility level, the percentages of Medicaid nursing-facility payments spent on direct-care-worker and support-staff compensation.

The proposal addresses federal Medicaid payment-transparency reporting. It would not remove other payroll, staffing, Payroll-Based Journal, cost-reporting or state-specific documentation obligations.

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What is CMS asking about—but not yet changing?

CMS is seeking comments on whether the roles of physician assistants and nurse practitioners in long-term care facilities should be expanded, including visits currently required to be performed by physicians.

This is a request for information, not an immediate scope-of-practice change. Any future operational impact would also depend on federal action and applicable state licensing and practice laws.

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What remains unchanged today?

Until CMS publishes a final rule with an effective date, nursing homes should continue following existing requirements.

That means facilities should not stop current respiratory reporting, vaccination documentation, ombudsman notifications or other affected workflows merely because CMS has proposed removing them.

The proposal also does not remove the need for:

• Active professional licenses and certifications.
• Ongoing exclusion and sanction screening.
• Complete employee and contractor records.
• Vendor compliance documentation.
• Facility and equipment inspection records.
• Evidence supporting the facility assessment.
• Survey-ready audit trails showing when an item was reviewed, corrected and approved.

Less administrative burden does not mean less accountability. Surveyors, regulators and organizational leaders will still need evidence that the facility identified its requirements, assigned responsibility and maintained compliance.

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What should nursing-home leaders do now?

Keep current workflows active

Do not remove requirements from policies, checklists or software until a final rule is published and the relevant provision becomes effective.

Identify the workflows that could be affected

Map the proposal to infection-control reporting, vaccination documentation, ombudsman notices, facility assessments, physical-environment records and Medicaid reporting. This will make future implementation faster and safer.

Separate federal requirements from state and internal requirements

A federal requirement may be reduced while a state rule, corporate policy, collective-bargaining agreement or accreditation standard remains in place. Each obligation should have a clear source and effective date.

Review facility-assessment evidence

The facility assessment remains a foundational compliance document. Confirm that leadership can show who participated, which information was reviewed, how resident needs were evaluated and how staffing, training, equipment and vendor resources support those needs.

Consider submitting comments

CMS will accept comments through January 11, 2027. Providers and technology partners can offer practical information about which requirements create unnecessary work and how technology can make compliance processes more efficient without weakening resident protections.

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How Perla supports adaptable compliance

Regulations change, but facilities still need a reliable way to understand which requirements apply and produce supporting evidence.

Perla helps long-term care organizations centralize employee credentials, professional licenses, exclusion checks, vendor documents, facility records and equipment compliance evidence. Multi-site dashboards, automated reminders, recurring verification and audit history can help leaders see gaps earlier and retrieve documentation when it is needed.

For proposed rules such as CMS CARE, the practical value is control. Organizations can keep current requirements active, prepare future workflow changes and preserve a clear record of what applied at a specific point in time.

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Frequently asked questions

Is the CMS CARE proposal already effective?

No. It is a proposed rule. Current requirements remain in effect until CMS publishes a final rule and the applicable provisions reach their effective dates.

When are comments due?

Comments on CMS-3484-P are due January 11, 2027.

Does the proposal eliminate the nursing-home facility assessment?

No. CMS proposes removing the required active involvement of representatives of direct-care staff while retaining the remainder of the facility-assessment requirements.

Should facilities stop weekly respiratory reporting now?

No. The proposed removal is not yet effective. Facilities should continue following current federal and state requirements.

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The bottom line

The CMS CARE proposal could meaningfully reduce several administrative obligations for nursing homes. It also reinforces a broader lesson: compliance programs must be able to change without losing control of the evidence.

Nursing-home leaders should monitor the rulemaking, keep existing workflows active and prepare to update policies only after CMS finalizes the relevant provisions. The goal should not simply be less paperwork. It should be a clearer, more reliable compliance process.

Learn how Perla helps long-term care teams organize credentials, recurring verifications, vendor documents and survey evidence at goperla.com.

Sources

1. CMS Fact Sheet: Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care (CARE), CMS-3484-P, November 5, 2026.
2. Federal Register: Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care, published November 10, 2026, 91 FR 72634.
3. Regulations.gov docket CMS-2026-3631.

This article is for general informational purposes and does not constitute legal advice. Long-term care organizations should evaluate federal, state and local requirements applicable to their facilities.

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