CMS Releases Proposed Medicare SNF Prospective Payment System Rule 

Posted on April 6, 2026 by Jeff Bostic

Late last week, CMS released the annual proposed PPS rule. That rule, which will be adopted in final form around Aug. 1, implements annual rate updates and other Medicare policy changes impacting SNFs. This year’s rule proposes a 2.4% increase in SNF rates effective Oct. 1, reflecting relatively low inflation. Wage index values also update on that date, meaning the actual rate increase will vary from the inflation increase. 
  
The rule also includes a “request for information” related to increase in case mix under the Patient Driven Payment Model (PDPM). Despite multiple previous adjustments to rates to control for case mix increases under PDPM, CMS continues to see what they describe as a difference between “actual and expected” case mix values. They are asking for input on how to address the case mix increase, and they include an analysis showing that case mix would be reduced an average of over 4% if the “expected” values are used. If such an adjustment is adopted in the final rule, then Oct. 1 rates will amount to decreases for most SNFs. 
  
The proposed rule also includes updates to the Quality Reporting Program (QRP). CMS has proposed removing two COVID-19 vaccination measures from QRP—Vaccination Coverage Among Healthcare Personnel and Percent of Patients/Residents Who Are Up to Date—meaning facilities would no longer report healthcare personnel vaccination data through NHSN, and the resident vaccination item would be eliminated from the MDS starting in FY 27 if finalized. CMS also proposes revising QRP data submission requirements and expanding the program to include all SNF patients, regardless of payer. In addition, the agency is seeking input on adding Advance Care Planning as a future quality measure.