Latest articles and more

CMS to Relaunch PEPPER Compliance Reports After 3-Year Hiatus

The Centers for Medicare & Medicaid Services (CMS) said in late May that it will relaunch PEPPER reports for all provider types in “coming months,” restoring an important tool many nursing homes use for internal compliance and auditing purposes.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) reveals how often and to what extent facilities are billing traditional Medicare for key therapy and nursing services, and how long they’re keeping patients in-house. Claims data is used to show how a single facility’s claims in targeted, high-risk areas stack up against averages in their state and the nation.
The PEPPER reports are intended as a resource for the government’s own compliance work, each report is accessible to the measured facility so that it can assess its own trends and outlier data. PEPPER reports were last made available in April 2023. The following year, CMS said it would be pausing publication, reevaluating the metrics included and aiming to enhance their quality.
In an MLN Connects article (MLN Connects Newsletter for May 28, 2026 | CMS, CMS encouraged providers to ensure authorized officials, access managers and staff end users have access to the system. The agency also said providers could still expect to use the annual reports to:
• Spot billing patterns that may need review or improvement
• Identify areas that may need closer monitoring or internal audits
• Find services that may be under-coded or over-coded
• Track trends such as longer patient stays
• Take action before problems arise
The reports also clearly signal where providers can expect more government scrutiny and are most effective when used proactively.

PADONA Participation at LeadingAge PA Annual Conference & EXPO

The Pennsylvania Association of Directors of Nursing Administration (PADONA) will be actively participating in the upcoming LeadingAge PA Annual Conference & EXPO. This highly anticipated event will take place from May 11–13, 2026, and will be hosted at the Hershey Lodge in Hershey, PA.

On May 11^th, a representative from PADONA will deliver a presentation during the conference. Attendees will have the opportunity to gain valuable insights from PADONA’s expertise.

In addition to the presentation, PADONA will be exhibiting at the conference. We warmly invite all attendees to visit our booth throughout the event. By stopping by, you can learn more about the benefits of PADONA membership and discover the resources and support our organization provides.

CMS Changes Antipsychotic Medication Quality Measure in 2026 Using Hybrid Data

As of January 2026, the Centers for Medicare & Medicaid Services (CMS) will add a new method for capturing antipsychotic medication use among long-stay residents in skilled nursing facilities.
In addition to MDS-based data from section N, CMS is now using claims data to identify antipsychotic use. Because of this expanded data set, some facilities may notice an increase in their long-stay antipsychotic quality measure.
For instance, if a medication like prochlorperazine — commonly ordered for nausea — is omitted from the MDS due to a lack of awareness that it is classified as a first-generation antipsychotic, it will now be captured for the quality measure through Part D claims.
Effective January 2026 this change will be reflected in the Care Compare.gov publicly reported data. Review the revised Quality Measures User’s Manual for Long Stay Antipsychotic Measures.

Skilled Nursing Facility Data Validation Process

The Skilled Nursing Facility data validation process assesses the accuracy of Minimum Data Set (MDS)-based quality measures used in the SNF Value Based Purchasing (VBP) and Quality Reporting Programs (QRPs). The SNF data validation process has been established in response to Section 1888(h)(12) of the Social Security Act that requires the Secretary to apply a data validation process to SNF VBP and QRP measures. In the SNF Prospective Payment System (PPS) fiscal year (FY) 2024 final rule (CMS 1779-F) and FY 2025 final rule (CMS-1802-F), CMS specified that a data validation process for MDS based measures would be implemented to ensure accurate quality data beginning with the FY 2027 program year/FY 2025 performance period.
SNFs that submitted at least one MDS assessment record in the previous calendar year and have submitted at least one MDS assessment record in the current fiscal year are eligible for selection. Healthcare Management Solutions, LLC (HMS) is the data validation process contractor. HMS has an executed Data Use Agreement (DUA) with CMS and has the authority granted by CMS to request and receive medical records. No additional DUAs or other agreements are required to transmit medical records to HMS. The data validation process is scheduled to begin mid-January 2026.
Please see the CMS SNF Data Validation Process FAQs from CMS updated December 2025.

data-validation-process-frequently-asked-questions-12.17.2025

Respiratory Virus Outbreak Toolkit Upate

The Pennsylvania Department of Health has revised the Respiratory Virus Outbreak Toolkit. This was revised on November 24, 2025, from the 2024 version. This is information that is valuable for long term care infection preventionists to have and to use to determine managing respiratory virus outbreaks. This is also valuable information to share with medical directors, administrators, QAPI team members and when developing or revising policies and procedures related to respiratory virus outbreaks in the long-term care facilities.              Respiratory Virus Outbreak Toolkit updated 112425

Quality Measures User’s Manual (v17.0) issued by the Centers for Medicare and Medicaid Services (CMS)

The Centers for Medicare and Medicaid Services (CMS) issued version 17.0 of the MDS 3.0 Quality Measures User’s Manual which was effective January 1, 2025. The manual was issued to provide guidance regarding changes to measures that were updated by CMS.

NOTABLE CHANGES TO THE MDS QUALITY MEASURES (QM) USER’S MANUAL V17 Guidance on Selecting MDS Section GG Item Columns for Measure Calculation Guidance on the selection of MDS Section GG item columns (e.g., admission, discharge, OBRA/interim) has been revised to clarify that Section GG item values are determined by the target and/or prior assessment’s qualifying reason for assessment (RFA)1. Additional guidance on which GG item column to select when the target and/or prior assessment has more than one qualifying RFA, is also provided. The updated guidance will not have a significant impact on measure calculations.

Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (CMS ID: S038.02) (CMS Measures Inventory Tool [CMIT] Measure ID: 121)8 This quality measure is calculated using the SNF Quality Reporting Program measure Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (CMS ID: S038.02). To review the measure logic specifications for CMS ID: S038.02, please refer to the SNF Quality Reporting Program Measure Calculations and Reporting User’s Manual V6.0 on the SNF QRP website9 under the Downloads section at the bottom of the page. The measure logical specifications can be found in Chapter 8, Table 8-3.

The revised manual can be found at: MDS 3.0 Quality Measures User’s Manual v17.0