Key changes put forth in President Donald Trump’s proposed fiscal year 2026 budget may have downstream effects on the survey and certification of skilled nursing facilities.
The changes are part of HHS Secretary Robert Kennedy Jr.’s “Make America Healthy Again” initiative and include a restructuring of CMS to “streamline operations, maximize taxpayer value and improve healthcare outcomes for all Americans,” according to a Congressional Justification report on the proposed budget.
Here are three things to know about the proposed changes:
- CMS’ State Survey and Certification program facilitates oversight of more than 67,000 Medicare and Medicaid-certified facilities, including nursing homes, long-term care facilities, intermediate care facilities for individuals with intellectual disabilities, home health agencies and hospice agencies. The program collaborates with state level and private-sector organizations to conduct specialized surveys and investigations of these facilities.
Surveys are initiated to validate and recertify facilities, and respond to complaints filed against facilities. Depending on the severity, some complaint cases require surveyors to complete an onsite assessment within two to 10 days of the complaint.
Complaint survey levels surged during the COVID-19 pandemic and have since decreased, but occur at a significantly higher level than recertification and validation surveys, according to the report.
| Survey type | FY 2019 | FY 2022 | FY 2026 (projected) |
| Recertification and validation | 27,658 | 20,356 | 18,901 |
| Complaint | 69,779 | 91,456 | 82,890 |
Citing this higher level, the CMS budget prioritizes complaint survey funds and reduces support to standard surveys. The agency has notified surveying agencies to prioritize complaint surveys over recertification and validation.
- The budget request for the Survey and Certification program for fiscal 2026 is $442 million, compared to $412 million in fiscal year 2024.
Despite the proposed budget increase, survey completion rates are expected to decrease for some facilities.
| Facility type | FY 2024 (final) | FY 2026 (projected) |
| Nursing facilities | 75% | 100% |
| Skilled nursing facilities | 72% | 65% |
| Skilled nursing facilities and nursing facilities | 74% | 65% |
| Special focus facility nursing homes | 100% | 100% |
| Intermediate care facilities for individuals with intellectual disabilities | 84% | 100% |
| Home health agencies | 70% | 65% |
| Hospice agencies | 91% | 100% |
| Special focus program hospice agencies | 100% | Program paused |
Read CMS’ full congressional justification report here.
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