Our February 26, 2025 letter to the Center for Medicare and Medicaid Services (CMS) requests a delay in implementation of the revised Appendix PP Guidance to Surveyors for Long-Term Care Facilities of the State Operations Manual in light of the current regulatory freeze and the ongoing pause on external communications from the Department of Health & Human Services (HHS) and its agencies, including CMS, which significantly impairs nursing homes’ ability to interpret and implement this new guidance.