AHCA Summary of FY26 SNF Proposed Payment Rule

• By: Maureen Carland
• On: 04/16/2025 04:16:25
• In: Quality/Regulatory

The Centers for Medicare and Medicaid Services (CMS) last week issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2026 update. AHCA has reviewed the proposed rule and developed a summary outlining key provisions and impacts on members. 

The proposed rule:

• Would increase SNF PPS rates by 2.8%, or approximately $997 million, beginning October 1, 2025. This is based on the proposed SNF market basket increase of 3.0%, plus a 0.6% market basket forecast error adjustment, and a negative 0.8% productivity adjustment.
• Includes updates to PDPM ICD-10 code mappings and the SNF Quality Reporting Program. There were no proposed changes to the SNF Value-Based Purchasing Program for FY26, but future year changes are proposed for comment.
• Includes a request for information (RFI) for streamlining regulations and reducing administrative burdens. In every Medicare payment rule issued last week, CMS announced this RFI to comply with President Trump's Executive Order “Unleashing Prosperity Through Deregulation.”

The proposed changes are detailed in the AHCA summary- Click Here to Read the Summary. Overall, AHCA is encouraged by the proposed rule and looks forward to submitting comments by June 29, 2025.  If you have any questions for AHCA, please contact Martin Allen.
 
Staff contact: mcarland@mehca.org