A coalition of 12 state survey agencies has formally pushed back against CMS’s proposed changes to the skilled nursing facility survey process, arguing that the federal agency’s revisions to the Life Safety Code (LSC) inspection framework would create confusion, increase costs, and potentially compromise resident safety. The joint letter, sent to CMS Administrator on January 14, represents a rare unified front among state agencies that often operate independently.
What CMS Proposed
In November 2025, CMS released proposed guidance that would overhaul the LSC survey process for long-term care facilities. Key changes include consolidating the LSC and health surveys into a single, integrated inspection event (currently conducted separately), requiring surveyors to use a new digital inspection tool that replaces existing state-specific systems, reducing the standard survey window from 15 months to 12 months between inspections, and adding new fire safety and emergency preparedness elements to the standard survey protocol.
CMS argues these changes will improve efficiency, reduce burden on facilities by eliminating duplicate inspections, and create a more consistent national survey experience.
State Concerns
The 12-state coalition disagrees. Their primary concern is the mandatory adoption of CMS’s new digital inspection tool, which they say was developed without meaningful input from state survey agencies and lacks features present in existing state systems. Several states have invested millions in custom survey management platforms over the past decade and view the federal mandate as both wasteful and technically inferior.
States also raised concerns about the shortened survey window. With chronic surveyor shortages affecting nearly every state, reducing the interval from 15 to 12 months would require hiring approximately 800 additional surveyors nationwide—positions that many states cannot fund or fill in the current labor market.
The coalition specifically objects to the elimination of standalone LSC surveys, arguing that fire safety inspections require specialized expertise that may be diluted in an integrated survey format. “Life Safety Code compliance is literally a matter of life and death,” the letter states. “Folding it into a general health inspection risks turning it into a checkbox exercise.”
Industry Implications
For SNF operators, the outcome of this dispute will have direct operational impact. If CMS proceeds with the integrated survey model, facilities would face a single, more intensive inspection event rather than two separate surveys. This could simplify preparation in some respects but also raises the stakes of each inspection.
The shorter survey cycle would mean more frequent inspections, potentially increasing the likelihood of deficiency citations and the associated remediation burden. Operators in states with already aggressive survey schedules may see minimal change, while those in states that have historically operated at or near the 15-month maximum could face a significant adjustment.
Next Steps
CMS has a 60-day public comment period that closes in early February 2026. The agency is expected to publish a final rule by mid-2026, though the state coalition has requested a 90-day extension and a series of regional listening sessions. Given the breadth of opposition, industry observers expect CMS to modify at least some elements of the proposal before finalization.