Monitoring Nursing Homes' Engagement of Medical Directors

Medical directors at nursing homes are responsible for implementing resident care policies, coordinating medical care, and participating in quality assessment and assurance activities. Nursing homes are required to report hours worked by medical directors to CMS's Payroll-Based Journal (PBJ). The reported hours have raised concerns about nursing homes' employment and engagement of medical directors. But there may be limitations to the accuracy and utility of PBJ data on medical director hours. In this evaluation, we will assess: (1) the extent to which medical directors performed required duties in nursing homes, (2) the extent to which PBJ data on medical director hours are accurate and useful for oversight, and (3) opportunities to improve oversight and transparency of nursing homes' engagement and funding of medical directors through existing data or other monitoring mechanisms.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
June 2025	CMS	Monitoring Nursing Homes' Engagement of Medical Directors	Office of Evaluation and Inspections	OEI-07-25-00130	2026