Medicare SNF Payment Updates for 2026
Summary
This final rule finalizes changes and updates to the policies and payment rates used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year 2026. This final rule also updates the requirements for the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program.
Compliance Requirements
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Updates to the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year (FY) 2026, as required under section 1888(e)(4)(E) of the Social Security Act (the Act).; Removal of four standardized patient assessment data elements under the Social Determinants of Health (SDOH) category beginning with residents admitted on October 1, 2025, for the FY 2027 SNF Quality Reporting Program (QRP).; Amendment and codification of the reconsideration request policy and process for those SNFs requesting an extension to file a request for reconsideration.; Final performance standards for the FY 2028 and FY 2029 program years to comply with the SNF Value-Based Purchasing (VBP) Program’s statutory notice deadline.; Application of the previously finalized scoring methodology codified at 42 CFR 413.338(e)(1) and 413.338(e)(3) of our regulations to the SNF Within-Stay Potentially Preventable Readmission (SNF WS PPR) measure beginning with the FY 2028 program year.; Removal of the Health Equity Adjustment to simplify the scoring methodology and provide clearer incentives for SNFs as they seek to improve their quality of care for all residents.; Adoption of a reconsideration process that will allow SNFs to seek reconsideration of a review and correction request if they are not satisfied with CMS’s decision on that request, beginning with the FY 2027 program year.
Deadline: 2025-10-01(October 1, 2025)
Market Impacts
Finalizes changes and updates to the policies and payment rates under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year 2026, including updates to the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program.; Removal of four standardized patient assessment data elements under the Social Determinants of Health (SDOH) category beginning with residents admitted on October 1, 2025, for the FY 2027 SNF QRP.; Amendment of the Reconsideration Request Policy and Process for those SNF’s requesting an extension to file a request for reconsideration.; Updates to the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program, including providing final performance standards, removing the Health Equity Adjustment from the Program’s scoring methodology, and applying the Program’s scoring methodology to the Skilled Nursing Facility Within-Stay Potentially Preventable Readmission (SNF WS PPR) measure.
Validated Company Impacts
Acadia Healthcare Company, Inc.
The rule directly addresses the company's third-ranked risk factor 'Medicare and Medicaid Reimbursement Risks' by updating payment rates and policies under the Skilled Nursing Facility Prospective Payment System for FY 2026. This creates strong alignment as changes to reimbursement structures could significantly impact revenue, matching the company's identified regulatory compliance concern.
BrightSpring Health Services, Inc.
The rule directly addresses multiple key risks identified by the company, particularly 'Changes in Medicare and Medicaid rates' and 'Regulatory changes in healthcare' which are explicitly mentioned in the company's top risks. The rule's focus on SNF payment system updates, quality reporting requirements, and value-based purchasing programs creates significant financial and regulatory compliance impacts that align perfectly with the company's risk profile.
ENSIGN GROUP, INC
Ensign Group operates skilled nursing facilities (SNFs) as its core business, directly falling under the jurisdiction of this Medicare rule which specifically targets SNFs for payment system updates, quality reporting, and value-based purchasing requirements. The company's entire business model is centered around skilled nursing care that is subject to Medicare reimbursement regulations.
Surgery Partners, Inc.
The rule directly impacts reimbursement rates and regulatory compliance for skilled nursing facilities, which aligns perfectly with the company's identified 'Revenue Concentration' risk (susceptibility to reimbursement rate changes) and 'Healthcare Regulations' risk (regulatory changes imposing additional costs and operational constraints). These are material financial and regulatory risks that would significantly affect the company's operations.
Option Care Health, Inc.
The federal rule directly impacts skilled nursing facility payment systems and quality reporting requirements, which aligns perfectly with the company's identified 'Healthcare regulatory changes' risk involving increased compliance costs and operational restrictions. The rule's focus on reimbursement rate updates and quality program modifications directly corresponds to the company's 'Dependency on third-party payers' risk regarding adverse financial impacts from reimbursement changes.