in effect
This is a final rule from the Centers for Medicare & Medicaid Services (CMS) setting the Medicare payment rates and program requirements for skilled nursing facilities (SNFs) for federal fiscal year 2026, which runs from October 1, 2025 through September 30, 2026. It updates how much Medicare pays SNFs per day for patient care, adjusts the rules facilities must follow to report quality data, and modifies the program that ties a portion of SNF payments to performance scores.
Medicare payment rates for SNFs will increase by a net 3.2 percent for FY 2026, calculated as a 3.3 percent market basket update, plus a 0.6 percentage point correction for a prior-year forecast error, minus a 0.7 percentage point productivity adjustment required by law. Four data elements that SNFs were required to collect and report under the Social Determinants of Health category are being removed from the Quality Reporting Program starting with residents admitted on or after October 1, 2025. The SNF Value-Based Purchasing Program is dropping its Health Equity Adjustment from its scoring formula, adding a new readmission measure (the Within-Stay Potentially Preventable Readmission measure) to its scoring starting in FY 2028, and creating a formal reconsideration process so SNFs can appeal CMS decisions on review and correction requests beginning with the FY 2027 program year. SNFs that fail to submit required quality data will still face a 2.0 percentage point reduction to their market basket update.
Skilled nursing facilities that bill Medicare are directly affected — the payment rate change determines how much revenue they receive per patient day for Medicare Part A stays. Medicare beneficiaries receiving post-hospital skilled nursing care are indirectly affected, as payment adequacy influences SNF operations, staffing, and access to care.