Nursing Homes' Medicare Rates and Reports Get 2026 Refresh
Published Date: 4/30/2025
Proposed Rule
Summary
Starting in fiscal year 2026, skilled nursing facilities (SNFs) will see updated payment rates and new rules for how Medicare pays them. The changes also tweak quality reporting and value-based programs to boost care and fairness. SNFs and Medicare users should watch for these updates, with feedback due by June 30, 2025, and potential impacts on payments and care quality.
Analyzed Economic Effects
6 provisions identified: 4 benefits, 2 costs, 0 mixed.
FY2026 SNF Payment Update: 2.8% Net Increase
For fiscal year (FY) 2026 (October 1, 2025 through September 30, 2026) the proposed SNF market-basket update net of forecast error and productivity adjustments is 2.8 percent. CMS proposes component per diem amounts for FY 2026 (examples: Urban PT $75.42, OT $70.20, Nursing $131.47; Rural PT $85.98, OT $78.96, Nursing $125.61). CMS estimates the overall aggregate effect is an increase of $997 million in payments to SNFs during FY 2026.
SNF VBP Program Payment Reductions
CMS estimates the SNF Value-Based Purchasing (VBP) Program changes will reduce aggregate payments to SNFs by $208.36 million in FY 2026 and by $207.99 million in FY 2027. The proposed rule also proposes estimated performance standards for FY 2028 and FY 2029 and would apply the Program's scoring methodology to the SNF Within-Stay Potentially Preventable Readmission (SNF WS PPR) measure beginning with the FY 2028 program year.
Changes to SNF QRP Reconsideration Process and Extension Cost
CMS proposes to amend and codify the SNF Quality Reporting Program reconsideration request policy and process, and estimates that permitting an extension to file a reconsideration request will increase costs to those SNFs requesting an extension by $2,391.90 annually.
Removal of Four SDOH Assessment Data Elements
Beginning with residents admitted on October 1, 2025 (for the FY 2027 SNF QRP), CMS proposes to remove four standardized patient assessment data elements in the social determinants of health (SDOH) category from the SNF Quality Reporting Program. CMS estimates this proposed removal would result in an overall decrease of $2,228,563.12 annually to SNFs beginning with the FY 2027 SNF QRP.
Removal of Health Equity Adjustment; New VBP Reconsideration Process
CMS proposes to remove the Health Equity Adjustment from the SNF VBP Program methodology to ‘simplify the methodology and provide clearer incentives,’ and to adopt a SNF VBP program reconsideration process that would allow SNFs to appeal CMS's decisions on review and correction requests beginning with the FY 2027 program year.
PDPM ICD-10 Mapping Technical Updates
CMS proposes technical revisions to the code mappings used to classify patients under the Patient Driven Payment Model (PDPM) to improve payment and coding accuracy. These updates are intended to change how certain diagnoses map to PDPM classifications.
Personalized for You
How does this regulation affect your finances?
Personalize government policy and PRIA will tell you what this federal register document means for your household, plus every other regulation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-20281, Global Benchmark for Efficient Drug Pricing (GLOBE) Model
Starting November 30, 2026, Medicare will use the new GLOBE Model to help lower the cost of certain drugs for people on Original Medicare. This model changes how drug price increases are calculated, aiming to save money for both patients and the Medicare program without cutting care quality. If you’re on Medicare Part B, expect smarter drug pricing that helps keep your healthcare affordable.
2026-20131, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program; Correction
This correction fixes some technical mistakes in the Medicare payment rules for inpatient rehab facilities starting October 1, 2026. It mainly affects hospitals and rehab centers by clarifying how wage data and payments are calculated, ensuring fairer payment rates for fiscal year 2027. No big changes in money, but it keeps everything accurate and on track.
2026-19959, Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027; Correction
This correction fixes some technical mistakes in Medicare payment rules for skilled nursing facilities starting October 1, 2026. It mainly affects how hospital data is used to calculate payments, making sure no current hospitals are wrongly excluded. These tweaks help keep Medicare payments fair and accurate for providers and patients.
2026-20067, Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements; Correction
This correction fixes some technical mistakes in the FY 2027 hospice payment and wage index rules that were first published in August 2026. It mainly affects hospice providers by updating how their payments are calculated, making sure the numbers are accurate starting October 1, 2026. These changes help ensure hospices get the right payment amounts based on the latest hospital wage data.
2026-19946, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; Other Policy Changes; and Adoption of Updated Versions of Certain Health Information Technology Standards; Correction
This update fixes some typos and technical mistakes in the Medicare payment rules for hospitals starting October 1, 2026. It affects hospitals getting paid for patient care, making sure the payment system and quality programs run smoothly. These corrections help hospitals get the right payments and follow updated health tech standards without delays or confusion.
2026-15652, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program
This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2027. As required by statute, this final rule includes the classification and weighting factors for the IRF prospective payment system's (PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2027. It also finalizes the third and final of the 3-year phaseout of the rural adjustment, which began in FY 2025. This final rule includes a solicitation for public comments on alternative data sources for the IRF PPS wage index; requires all therapy treatments and/or therapy evaluations to begin no later than 36 hours from midnight on the day of admission; finalizes requirements for the initial Interdisciplinary Team meeting to occur on or before 4 days from the date the patient is admitted; and summarizes a request for information on potential future IRF PPS payment reform. Additionally, this final rule includes updates to the IRF Quality Reporting Program and changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
Previous / Next Documents
Previous: 2025-06336, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2026 and Updates to the IRF Quality Reporting Program
Starting in fiscal year 2026, Medicare is updating how it pays inpatient rehab facilities, including changes to payment rates and how patient cases are grouped. The rule also continues to phase out extra payments for rural facilities and updates quality reporting rules. These changes affect rehab centers and could impact their funding starting October 1, 2025.
Next: 2025-07351, Energy Conservation Program: Notification of Petition for Rulemaking
Dyson asked the Department of Energy to change how air cleaners’ room size and energy use are tested and shown to customers. Right now, DOE isn’t making any changes but wants to hear what people think before deciding. If you have ideas or info, you can share them by May 30, 2025, so this could affect air cleaner makers and buyers soon.