The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2026. Key provisions include:
- Increasing the per-diem federal rate by a net 3.4% after the market basket update, productivity adjustment and other adjustments. SNFs that fail to satisfy Quality Reporting Program requirements will be subject to a 2-percentage point reduction to the market basket update.
- Updating the labor-related share of the per diem rate from 72% to 71.9%.
- Making technical changes to the Patient-Driven Payment Model ICD-10 code mapping that assigns patients to clinical categories.
- Removing four elements recently adopted as standardized patient assessment data elements under the social determinants of health category, including:
- One item for living situation, two items for food and one item for utilities.
- Removing the health equity adjustment from the SNF Value-Based Purchasing program scoring methodology beginning for the FY 2027 program year.
The MHA will provide SNFs with an updated facility-specific impact analysis and additional details on the final rule in the coming weeks. Members with questions should contact Vickie Kunz at the MHA.