On November 5, 2026, CMS issued the much anticipated Cutting Administrative Requirements for Excellence in Patient Care (CARE) proposed rule (CMS-3484-P). If finalized, this rule would revise the Conditions of Participation, Conditions for Coverage, and Requirements for Participation across Medicare- and Medicaid-participating providers and suppliers. And all in all, CMS estimates the package would save $320 million and return more than 3.26 million hours of staff time to providers.
At this point this is a proposal, not a final rule, so nothing changes for your facility today. But when a rule like this is finalized, the real work lands on your compliance, education, and operations teams: which training changes, which attestations go away, and which reporting tasks shift.
Here is a summary of what this proposed rule could change for your facility.
What the proposed rule would change for skilled nursing facilities
Here are the proposed changes CARE identifies for long-term care facilities:
Reduce burden of COVID-19 vaccine requirements
- Remove the requirements to educate staff about the benefits and risks of the COVID-19 vaccine, offer it, and document those actions.
- Streamline the remaining COVID-19 vaccine requirements for residents.
Reduce burden of respiratory illness data reporting
- Remove the continuing respiratory illness data reporting requirement, while retaining specific reporting during a future Secretary-declared public health emergency.
Modified process for state ombudsman notice of transfers
- Modify the requirement to give the state ombudsman notice of resident transfers related to emergent care.
- CMS is also soliciting comment on allowing residents to opt out of having a discharge notice sent to the ombudsman office.
Revised requirements for facility assessment
- Revise the requirements for the active involvement of direct care staff representatives in conducting the facility assessment.
Revised physical environment requirements
- Exempt existing facilities from the room occupancy and bathroom facility standards.
- Adopt the 2024 editions of the NFPA Life Safety Code and Health Care Facilities Code, and the 2022 edition of the Emergency and Standby Power Systems codes.
- Remove the requirement that patient care areas have access to natural light and ventilation through exterior windows and doors (this applies to LTC facilities and several other provider types).
- Codify CMS's authority to permit facilities to comply with specific provisions of a newer edition of the LSC or HCFC.
Medicaid payment transparency
- Rescind the Medicaid institutional payment transparency reporting requirements covering the percentage of Medicaid payments for nursing facility services spent on compensation for direct care workers and for support staff. (A parallel support-staff requirement for ICFs/IID would also be rescinded.) This is aimed at reducing burden for states and institutional providers.
Additionally, CMS is seeking public input on a few open questions. These include whether to expand the scope of practice for physician assistants and nurse practitioners providing care in long-term care facilities, particularly for visits currently required to be performed by a physician. CMS is also asking for ideas on future policies to address Medicaid institutional workforce shortages and strengthen the institutional workforce.
Hospitals get relief too
SNFs are not the only providers in scope. CMS also proposes the following for hospitals and critical access hospitals:
- Remove staff training requirements for transfer protocols and emergency services readiness (currently effective), and for obstetric care (otherwise effective Jan. 1, 2027).
- Remove obstetric-specific QAPI requirements (otherwise effective Jan. 1, 2027).
- Establish new patients' rights requirements around birth tissue collection for hospitals and CAHs providing obstetric services, including informed consent standards and policies to support families who request their birth tissues for cultural, religious, or personal reasons.
- For CAHs, clarify how distance eligibility is determined and implement statutory exemptions from distance requirements for CAHs meeting qualifying criteria.
- Remove COVID-19 and seasonal influenza reporting requirements for Rural Emergency Hospitals, along with REH data reporting during a PHE.
CMS is also seeking comments on strategies to ease hospital and CAH respiratory illness reporting, on flexibility around physician supervision of CRNAs, and on transplant program certification criteria.
How Showd.me supports you through this change
A proposed rule is only useful if your training program keeps pace with it, and that should not fall on your team alone. At Showd.me, we will be monitoring the CARE proposed rule as it moves through public comment and finalization. Once the rule is final, we will publish our recommended training program changes and break down what the changes mean for provider organizations.
What you can do now
- Keep current requirements in place until a final rule is published and effective.
- Review which of your trainings, attestations, and reporting tasks relate to the provisions above, such as COVID-19 vaccine education, respiratory illness reporting, facility assessment, or Medicaid reporting.
- Loop in your environment-of-care and finance leaders, since several proposals extend beyond training and workforce management.
- Decide whether you want to submit comments to CMS while the comment period is open.
Questions about how CARE could affect your training programs? Connect with our team to learn how Showd.me helps providers stay current with regulatory change.