The Centers for Medicare and Medicaid Services (CMS) on April 3, 2026, made additional clarifications to Chapter 7 Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities.

CMS previously released significant updates to Chapters 5 and 7 of the State Operations Manual in January 2026, but the updates were not changes to policy; rather, they updated the manual to be consistent with current policies and practices. Note that revised memo still shows the original January updates highlighted by red text, making it difficult to identify the April 3 changes.

In the April 3 revised memo, CMS clarified that abbreviated surveys must be completed on two consecutive calendar days beginning with the date of survey entrance. CMS also provided examples for enforcing per day and per instance civil money penalties (CMPs) and clarified that CMP amounts are hypothetical only, based on original amounts not adjusted for inflation, and that actual CMP amounts will be determined based on instructions in the CMP Analytic Tool, required for surveyors and available to providers and the public. The revisions will be applicable to all enforcement cycles starting on and/or after March 31, 2026.

CMS further announced that per instance CMPs will be displayed on Nursing Home Care Compare beginning June 24, 2026.