The Centers for Medicare & Medicaid Services (CMS) on Thursday released its Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2026.
The final rule, which includes updates to Medicare payment policies and rates for SNFs, will be published in the Federal Register on August 4.
Here is an overview of the major changes:
Payment rates: CMS will increase SNF PPS rates by 3.2 percent based on the final SNF market basket of 3.3 percent, plus a 0.6 percent market basket forecast error adjustment, and a negative 0.7 percent productivity adjustment. CMS said in a fact sheet that the update amounts to an increase in payments of $1.16 billion compared to payments in FY 2025.
ICD-10 code mappings for the patient-driven payment model: CMS will update the code mappings for providers to make more accurate, consistent, and appropriate primary diagnoses that meet the criteria for skilled intervention during a Part A SNF stay. CMS finalized 34 changes to code mappings to coincide with the latest ICD-10 coding guidance.
Value-based purchasing: CMS has finalized statutorily required performance standards for program measures and removed the Health Equity Adjustment from the scoring methodology.
Quality reporting: CMS will remove four standardized patient assessment data elements under the Social Determinant of Health (SDOH) category from the Minimum Data Set (MDS), beginning with residents admitted on October 1, 2025, for the FY 2027 SNF QRP. These data elements are one item for “living situation,” two items for “food,” and one item for “utilities.”
RFI on streamlining regulations: CMS seeks feedback on ways to streamline regulations and reduce burdens on those participating in the Medicare program through a standalone RFI. Responses are due by September 15, 2025.