CMS proposes 2.8% skilled nursing facility payment bump
Adjustments are estimated to total $196.5 million in 2026, CMS says.
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The Centers for Medicare and Medicaid Services is making updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year 2026.
CMS is proposing updating SNF PPS rates by 2.8% based on the proposed market basket of 3%, plus a 0.6% market basket forecast error adjustment and a negative 0.8% productivity adjustment.
Those adjustments are estimated to total $196.5 million, CMS said. The figures do not incorporate the SNF Value-Based Purchasing (VBP) reductions for certain SNFs subject to the net reduction in payments under the SNF VBP.
Last year, CMS proposed a 4.1% payment increase for skilled nursing facilities.
WHAT'S THE IMPACT
For the NSF Value-Based Purchasing (VBP) program, CMS is proposing a series of operational and administrative proposals as part of this year's rule. Operationally, this includes proposing statutorily required scoring policy updates to the SNF VBP program. Proposed administrative updates include the creation of a reconsideration policy and the removal of the Program's Health Equity Adjustment, the agency said.
A pay-for-performance program, CMS withholds 2% of SNFs' Medicare fee-for-service (FFS) Part A payments to fund the SNF VBP Program – known as the "withhold" – and the agency is then required to redistribute between 50% and 70% of this withhold to SNFs as incentive payments depending on their performance in the program. CMS applies incentive payments prospectively to all FFS Part A claims paid under the SNF PPS for the applicable program year.
CMS is proposing to apply the previously finalized scoring methodology of the program to the SNF Within-Stay Potentially Preventive Readmission (SNF WS PPR) measure beginning with the FY 2028 program year. It's also providing estimated performance standards for the FY 2028 and FY 2029 program years to comply with the program's statutory notice deadline.
CMS said it's proposing to remove the SNF VBP Program's Health Equity Adjustment, ostensibly to "simplify the methodology" and provide clearer incentives.
THE LARGER TREND
For the SNF Quality Reporting Program (QRP), CMS is proposing to remove four standardized patient assessment data elements under the Social Determinant of Health (SDOH) category, including one item for "living situation," two items for "food" and one item for "utilities."
The agency is also seeking input on several RFIs, specifically: future measure concepts on the topics of delirium, interoperability, nutrition and well-being; revisions to the current data submission deadlines for assessment data, which CMS said would allow it to provide SNFs with more timely quality data; and advancing digital quality measurement and the use of Fast Healthcare Interoperability Resources (FHIR) in the SNF QRP.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
