This week, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2027. The final rule is virtually the same as the proposed rule issued earlier this year and finalizes a 2.4% increase to Medicare Part A rates in FY 2027.
AHCA/NCAL President & CEO Clif Porter commented, “We appreciate CMS for recognizing the importance of maintaining stable Medicare reimbursement for skilled nursing facilities. Reimbursement policy that reflects the increasing needs of our patients and the increasing costs to deliver that care is essential to supporting seniors and their caregivers."
Highlights of the finalized rule include:
- Payment Rates: The final rule will increase SNF PPS rates by 2.4% - or approximately $883 million - beginning October 1, 2026. This is based on the SNF market basket increase of 3.3%, minus a 0.9% productivity adjustment. This net update will vary geographically.
- SNF Quality Reporting Program (QRP) Updates:
- The rule finalizes removal of two measures starting in FY 2028: 1) The COVID-19 Vaccination Coverage among Healthcare Personnel measure, and 2) The COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure.
- CMS revised the timeframe for data submission from 4.5 months to approximately 45 days, beginning with the FY 2029 SNF QRP.
- CMS also finalized a significant expansion of the SNF QRP with additional reporting requirements starting in October 2029. SNFs will need to submit MDS quality information for all residents receiving covered skilled care, regardless of payer, aligning with other post-acute care quality programs. AHCA/NCAL is disappointed to see this provision finalized as it will increase administrative burden without directly improving clinical care for patients.
- SNF Value-Based Purchasing (VBP) Updates:
- CMS provided estimated performance standards for the FY 2029 and FY 2030 program years to comply with the Program's statutory notice deadline.
- The agency finalized an update to the “snapshot dates" for two MDS-based measures (1. DC Function and 2. Major Injury [Long-Stay]) to maintain alignment with the finalized revisions to SNF QRP submission deadlines for MDS assessment data, beginning with FY 2027 data.
- Request for Information on the Patient Driven Payment Model (PDPM): CMS did not provide responses to comments submitted on this RFI.
Learn more from the CMS
fact sheet and view the final rule in the
Federal Register.
AHCA/NCAL remains committed to working with CMS on policies that further invest in strengthening access to high-quality, post-acute care while streamlining reporting in order to put patients over paperwork. We will also continue to focus on the impact of any future payment reforms.
For questions, please reach out to SVP of Reimbursement Policy
John Kane.