Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026

DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Part 413</CFR> <DEPDOC>[CMS-1827-P]</DEPDOC> <RIN>RIN 0938-AV47</RIN> <SUBJECT>Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Proposed rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This proposed rule would change and update policies and payment rates used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for FY 2026. This rulemaking also proposes to update the requirements for the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> To be assured consideration, comments must be received at one of the addresses provided below, by June 30, 2025. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> In commenting, please refer to file code CMS-1827-P. Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed): 1. <E T="03">Electronically.</E> You may submit electronic comments on this regulation to <E T="03">http://www.regulations.gov.</E> Follow the “Submit a comment” instructions. 2. <E T="03">By regular mail.</E> You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1827-P, P.O. Box 8016, Baltimore, MD 21244-8016. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. <E T="03">By express or overnight mail.</E> You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1827-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, see the beginning of the <E T="02">SUPPLEMENTARY INFORMATION</E> section. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Patricia Taft, (410) 786-4561, for issues related to the SNF PPS. Heidi Magladry, (410) 786-6034, for information related to the skilled nursing facility quality reporting program. Christopher Palmer, (410) 786-8025, for information related to the skilled nursing facility value-based purchasing program. </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <E T="03">Inspection of Public Comments:</E> All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: <E T="03">http://www.regulations.gov.</E> Follow the search instructions on that website to view public comments. CMS will not post on <E T="03">Regulations.gov</E> public comments that make threats to individuals or institutions or suggest that the commenter will take actions to harm an individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments. <E T="03">Plain Language Summary:</E> In accordance with 5 U.S.C. 553(b)(4), a plain language summary of this rule may be found at <E T="03">https://www.regulations.gov/.</E> <E T="03">Unleashing Prosperity Through Deregulation of the Medicare Program—Request for Information:</E> On January 31, 2025, President Trump issued Executive Order (E.O.) 14192 “Unleashing Prosperity Through Deregulation,” which states the Administration policy to significantly reduce the private expenditures required to comply with Federal regulations to secure America's economic prosperity and national security and the highest possible quality of life for each citizen. We would like public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries, and other stakeholders participating in the Medicare program. CMS has made available a Request for Information (RFI) at: <E T="03">https://www.cms.gov/medicare-regulatory-relief-rfi.</E> Please submit all comments in response to this request for information through the provided weblink. <HD SOURCE="HD1">Availability of Certain Tables Exclusively Through the Internet on the CMS Website</HD> As discussed in the FY 2014 SNF PPS final rule (78 FR 47936), tables setting forth the Wage Index for Urban Areas Based on CBSA Labor Market Areas and the Wage Index Based on CBSA Labor Market Areas for Rural Areas are no longer published in the <E T="04">Federal Register</E> . Instead, these tables are available exclusively through the internet on the CMS website. The wage index tables for this proposed rule can be accessed on the SNF PPS Wage Index home page, at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.</E> Readers who experience any problems accessing any of these online SNF PPS wage index tables should contact Patricia Taft at (410) 786-4561. To assist readers in referencing sections contained in this document, we are providing the following Table of Contents. <HD SOURCE="HD1">Table of Contents </HD> <EXTRACT> <FP SOURCE="FP-2">I. Executive Summary</FP> <FP SOURCE="FP1-2">A. Purpose</FP> <FP SOURCE="FP1-2">B. Summary of Major Provisions</FP> <FP SOURCE="FP1-2">C. Summary of Cost and Benefits</FP> <FP SOURCE="FP-2">II. Background on SNF PPS</FP> <FP SOURCE="FP1-2">A. Statutory Basis and Scope</FP> <FP SOURCE="FP1-2">B. Initial Transition for the SNF PPS</FP> <FP SOURCE="FP1-2">C. Required Annual Rate Updates</FP> <FP SOURCE="FP-2">III. Proposed SNF PPS Rate Setting Methodology and FY 2026 Update</FP> <FP SOURCE="FP1-2">A. Federal Base Rates</FP> <FP SOURCE="FP1-2">B. SNF Market Basket Update</FP> <FP SOURCE="FP1-2">C. Case-Mix Adjustment</FP> <FP SOURCE="FP1-2">D. Wage Index Adjustment</FP> <FP SOURCE="FP1-2">E. SNF Value-Based Purchasing Program</FP> <FP SOURCE="FP1-2">F. Adjusted Rate Computation Example</FP> <FP SOURCE="FP-2">IV. Additional Aspects of the SNF PPS</FP> <FP SOURCE="FP1-2">A. SNF Level of Care—Administrative Presumption</FP> <FP SOURCE="FP1-2">B. Consolidated Billing</FP> <FP SOURCE="FP1-2">C. Payment for SNF-Level Swing-Bed Services</FP> <FP SOURCE="FP-2">V. Other SNF PPS Issues</FP> <FP SOURCE="FP1-2">Technical Updates to PDPM ICD-10 Mappings</FP> <FP SOURCE="FP-2">VI. Skilled Nursing Facility Quality Reporting Program (SNF QRP)</FP> <FP SOURCE="FP1-2">A. Background and Statutory Authority</FP> <FP SOURCE="FP1-2">B. General Considerations Used for the Selection of Measures for the SNF QRP</FP> <FP SOURCE="FP1-2">C. Proposal To Remove Four Standardized Patient Assessment Data Elements Beginning With the FY 2027 SNF QRP</FP> <FP SOURCE="FP1-2">D. Proposals To Amend the Reconsideration Request Policy and Process</FP> <FP SOURCE="FP1-2">E. SNF QRP Measure Concepts Under Consideration for Future Years—Request for Information (RFI): Interoperability, Well-Being, Nutrition & Delirium</FP> <FP SOURCE="FP1-2"> F. Potential Revision of the Final Data Submission Deadline From 4.5 Months to 45 Days—Request for Information (RFI) </FP> <FP SOURCE="FP1-2">G. Advancing Digital Quality Measurement in the SNF QRP—Request for Information (RFI)</FP> <FP SOURCE="FP1-2">H. Form, Manner, and Timing of Data Submission Under the SNF QRP</FP> <FP SOURCE="FP1-2">I. Policies Regarding Public Display of Measure Data for the SNF QRP</FP> <FP SOURCE="FP-2">VII. Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program</FP> <FP SOURCE="FP1-2">A. Statutory Background</FP> <FP SOURCE="FP1-2">B. Proposed Removal of the Health Equity Adjustment From the SNF VBP Program Scoring Methodology</FP> <FP SOURCE="FP1-2">C. SNF VBP Program Measures</FP> <FP SOURCE="FP1-2">D. SNF VBP Performance Standards</FP> <FP SOURCE="FP1-2">E. SNF VBP Performance Scoring Methodology</FP> <FP SOURCE="FP1-2">F. Proposal To Adopt a SNF VBP Program Reconsideration Process</FP> <FP SOURCE="FP-2">VIII. Collection of Information Requirements</FP> <FP SOURCE="FP-2">IX. Response to Comments</FP> <FP SOURCE="FP-2">X. Economic Analyses</FP> <FP SOURCE="FP1-2">A. Regulatory Impact Analysis</FP> <FP SOURCE="FP1-2">B. Regulatory Flexibility Act Analysis</FP> <FP SOURCE="FP1-2">C. Unfunded Mandates Reform Act Analysis</FP> <FP SOURCE="FP1-2">D. Federalism Analysis</FP> <FP SOURCE="FP1-2">E. Regulatory Review Costs</FP> <FP SOURCE="FP1-2">F. E.O. 14192, “Unleashing Prosperity Through Deregulation” </FP> </EXTRACT> <HD SOURCE="HD1">I. Executive Summary</HD> <HD SOURCE="HD2">A. Purpose</HD> This proposed rule would update the SNF prospective payment rates for fiscal year (FY) 2026, as required under section 1888(e)(4)(E) of the Social Security Act (the Act). It also responds to section 1888(e)(4)(H) of the Act, which requires the Secretary to provide for publication of certain specified information relating to the payment update (see section II.C. of this proposed rule) in the <E T="04">Federal Register</E> before the August 1 that precedes the start of each FY. We are also proposing several technical revisions to the code mappings used to classify patients under the Patient Driven Payment Model (PDPM) to improve payment and coding accuracy. We are proposing updates to the requirements for the SNF QRP by removing four standardized patient ass ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 251k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━