Tag: skilled nursing facilities

CMS Releases FY 2026 Final Rule for Skilled Nursing Facilities

Member News

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.

CMS Releases FY 2026 Proposed Rule for Skilled Nursing Facilities

Member News

The  Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service prospective payment system for skilled nursing facilities (SNFs) for fiscal year (FY) 2026.

Key provisions of the proposed rule include:

  • Increasing the per-diem federal rate by a net 3% 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.
  • 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 items recently adopted as standardized patient assessment data elements under the social determinants of health category.
  • Issuing three Requests for Information regarding future measure concepts, potential revisions to submission deadlines for assessment data collected and advancing digital quality measurement.
  • Removing the health equity adjustment from the SNF Value-Based Purchasing program.

The CMS is seeking comments on opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries and other interested parties participating in the Medicare program.

The MHA will provide SNFs with a facility-specific impact analysis and additional details on the proposed rule in the near future. The MHA also encourages members to submit comments to the CMS by June 10 and to contact Vickie Kunz at the MHA with questions and issues identified by May 27.

CMS Releases FY 2025 Final Rule for Skilled Nursing Facilities

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system (PPS) for skilled nursing facilities (SNFs) for federal fiscal year (FY) 2025.

Key provisions include:

  • Increasing the per diem federal rate by a net 4.2% after the market basket update, productivity adjustment and other adjustments.
  • Updating the base year data used to determine the SNF market basket from 2018 to 2022.
  • Updating the wage index used under the SNF PPS to reflect data from the 2020 decennial census.
  • Increasing the labor-related share of the per diem rate from 71.1% to 72%.
  • Making technical updates to the code mappings used to classify patients under the Patient Driven Payment Model that assigns patients to clinical categories.
  • Revising the regulations to allow the CMS to impose additional financial penalties on facilities with health and safety deficiencies as identified.
  • Adopting four new patient assessment items related to health-related social needs, with SNFs required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2027 SNF quality reporting program (QRP).
  • Modifying the transportation item on the patient assessment item to simplify response options while also using a defined 12-month look-back period.
  • Adopting a data validation process for the SNF QRP beginning with the FY 2027 program.
  • Proposing operational updates to the SNF Value-Based Purchasing program, including policies regarding measure removal and review and corrections.
  • Updating the case mix methodology used to calculate the Total Nurse Staffing measure.

The MHA will provide SNFs with an updated facility-specific impact analysis and additional details on the final rule, effective Oct. 1, in the near future. Members with questions should contact Vickie Kunz at the MHA.

CMS Releases FY 2025 Proposed Rule for Skilled Nursing Facilities

Member News

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule April 3 to update the Medicare fee-for-service (FFS) prospective payment system (PPS) for skilled nursing facilities (SNFs) for federal fiscal year (FY) 2025.

Key provisions of the proposed rule include:

  • Increasing the per diem federal rate by a net 4.1% after the market basket update, productivity adjustment and other adjustments.
  • Updating the base year data used to determine the SNF market basket from 2018 to 2022.
  • Updating the wage index used under the SNF PPS to reflect data from the 2020 decennial census.
  • Increasing the labor-related share of the per diem rate from 71.1% to 71.9%.
  • Making technical revisions to the code mappings used to classify patients under the Patient Driven Payment Model (PDPM) that assigns patients to clinical categories.
  • Revising the CMS nursing home enforcement authority to allow the agency to impose multiple financial penalties on facilities with safety deficiencies.
  • Adopting four new patient assessment items related to health-related social needs with SNFs required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2027 SNF quality reporting program (QRP).
  • Modifying the patient assessment item on transportation to simplify the response options and revise the look-back period.
  • Adopting a data validation process for the SNF QRP beginning with the FY 2027 program.
  • Proposing operational updates to the SNF Value-Based Purchasing program, including policies regarding measure removal and review and corrections.
  • Updating the case mix methodology used to calculate the Total Nurse Staffing measure.
  • A Request for Information (RFI) on potential updates to the Non-Therapy Ancillary component of the PDPM.

The MHA will provide SNFs with a facility-specific impact analysis and additional details on the proposed rule in the near future. The MHA also encourages members to submit comments to the CMS by May 28 and to contact the MHA with issues identified by May 22.

Members with questions should contact Vickie Kunz at the MHA.