CMS Releases Mission and Priorities Document (SNF)

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year 2026 Mission and Priorities Document (MPD), which maps the agency’s priorities. It outlines survey, certification, enforcement and Medicare funding allocations for states, while also providing background information on certified provider and supplier types, as well as accreditation and deeming surveys. Survey activities must be scheduled and conducted according to the priority tier structure in the MPD. Four tiers reflect statutory mandates and program emphasis, with Tier 1 representing the highest priority. 

Survey activity remains central to CMS oversight, and the agency continues to emphasize a tiered survey prioritization structure to ensure resources are focused where they are most needed.  

• Under Tier 1, nursing facilities must receive a standard recertification survey no later than every 15.9 months, with a national goal of maintaining a 12.9-month average between surveys. States are also required to conduct at least 10% of surveys during “off-hours,” with at least half of those completed on weekends. In addition, Special Focus Facilities must be surveyed at least once every 186 days.  
• Tier 2 requires states to maintain the 12.9-month average for nursing facility recertification, and it prioritizes initial certifications if applications have been pending for more than 150 days without a deeming option, or when CMS determines there is an access-to-care issue.  
• Tier 3 applies to Medicaid-only nursing facilities and other initial certifications not included in Tiers 1 or 2.

CMS shares that the agency is reinforcing timely survey practices, particularly for Special Focus Facilities. In addition to survey requirements in its priorities document, CMS discussed new initiatives designed to modernize oversight and address ongoing staffing challenges.