Late today, the Centers for Medicare and Medicaid Services (CMS) issued a number of rules, including the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) for fiscal year (FY) 2027. The rule proposes a modest 2.4% increase to Medicare Part A rates in FY 2027, which we were expecting and are pleased to see.
AHCA staff are currently reviewing the proposed rule, but for now, highlights include:
Payment Rates: The proposed rule would increase SNF PPS rates by 2.4% - or approximately $888 million - beginning October 1, 2026. This is based on the proposed SNF market basket increase of 3.2%, minus a 0.8% productivity adjustment. This net update will vary geographically.
SNF Quality Reporting Program (QRP) Updates:
- The proposed rule would remove 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 is also proposing to revise the timeframe for data submission from 4.5 months to no later than the 15th day of the second month after the end of the calendar quarter beginning with the FY 2029 SNF QRP.
- The agency is also seeking feedback on one potential measure for adoption in future years: advanced care planning.
SNF Value-Based Purchasing (VBP) Updates:
- CMS is providing estimated performance standards for the FY 2029 and FY 2030 program years to comply with the Program’s statutory notice deadline.
- The agency is proposing to update the “snapshot dates” for two MDS-based measures (1. DC Function and 2. Major Injury [Long-Stay]) to maintain alignment with the newly proposed 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 is asking for input on potential updates to PDPM to address Case Mix Upcoding as part of a broader effort to ensure that payment policy reflects current care practices and chances in the SNF resident population.
Thank you for your continued support. We look forward to submitting comments on the proposed rule and continuing to advocate for a sustainable reimbursement system.