CMS Proposes New Medicare Rule Impacting Skilled Nursing Facilities
The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for Medicare in April 2026, prompting healthcare providers to review and comment by June 1, 2026. Key highlights of the proposed changes include updates to payment rates, reporting requirements, and data collection procedures, all of which carry significant implications for skilled nursing facilities (SNFs).
The proposed rule suggests a 2.4% increase in the Medicare payment rate for SNFs, translating to an estimated $888 million boost. This increase factors in a 3.2% rise in the FY 2027 market basket for SNFs, offset by a 0.8% productivity adjustment. Despite the modest gains, facilities must assess this increase in context with ongoing cost pressures and operational challenges, including staffing.
Significant adjustments to the SNF Quality Reporting Program (QRP) are also outlined. CMS plans to remove two measures related to COVID-19 vaccination coverage from the QRP and revise submission deadlines for data. Starting with submissions based on data from calendar year 2027, new deadlines will be set for the 15th day of the second month after a quarter ends, with May 17, 2027, marking the first affected deadline. This change aims to enhance the timeliness of publicly available data, thus demanding vigilant monitoring of internal reports and assessments by SNFs.
Further, CMS seeks to unify data collection standards across all residents, irrespective of payer, aligning with rising Medicare Advantage enrollment trends. CMS asserts that a standardized data capture approach will yield a more accurate evaluation of SNF quality. Facilities should brace for additional staff effort to meet these comprehensive data reporting obligations as they pertain to resident admissions and re-admissions.
Under the proposed rule, SNFs would be required to submit Minimum Data Set (MDS) details for all residents receiving covered skilled care, starting with admissions on or after October 1, 2029. This includes submissions for non-fee-for-service residents at admission and discharge. CMS intends to modify the MDS to facilitate this new reporting mechanism, anticipating that regular monitoring will be essential to track discharge assessment completion.
While CMS made no adjustments to the Patient-Driven Payment Model (PDPM) ICD-10 code mappings, it continues to monitor SNF data for trends in case mix and is soliciting feedback on observed changes. This is particularly relevant to states that have adopted the PDPM for Medicaid reimbursement, as modifications to the Medicare structure could have implications for state Medicaid models.
Providers should coordinate closely among clinical, reimbursement, and administrative teams to manage these regulatory changes effectively. Ongoing engagement with industry groups is recommended as they gather feedback for submission to CMS. Providers are also encouraged to stay informed on developments regarding the proposed rule, considering its potential impacts and submitting feedback when appropriate. For further details, stakeholders may contact the Senior Living & Long-Term Care team at Forvis Mazars.