Industry Updates
August 1, 2025
SNF Prospective Payment Final Rule includes a 3.2% Increase for FY 2026
On July 31, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating Medicare payment policies and rates for skilled nursing facilities (SNFs) under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year 2026, which begins October 1.
This is higher than the proposed 2.8% proposed in April. Other key highlights include:
Value-Based Purchasing Program:
A new policy allows SNFs to appeal decisions made on review-and-correct reconsideration requests before data is made public.
Quality Reporting Program
CMS is removing four standardized patient assessment data elements related to social determinants of health (living situation, food, utilities).
These elements were deemed not reflective of or impacted by the SNF stay, and their removal was supported by LeadingAge.
Changes also include updates to the CMS reconsideration policy for noncompliance determinations.
To read the full article go to the link below:
SNF Prospective Payment Final Rule Includes 3.2% Increase for FY2026
July 2025
NOW AVAILABLE: Design for Care Compare Nursing Home Five Star Quality Rating System Technical User Guide
Effective with the July 2025 refresh, CMS is implementing a change to the methodology for calculating the health inspections domain, shifting from using the three most recent standard health inspection surveys to the two most recent standard health inspection surveys to calculate health inspection ratings. CMS will continue to use a three-year lookback period for complaint and infection control inspections. For more details on the updated methodology, please review the “Health Inspection Domain” section of this document. CMS is updating the risk-adjustment models for the four claims-based measures to add risk adjustors using variables from Section GG (resident’s functional ability) in the Minimum Data Set (MDS). To minimize the impact of this change, CMS is revising the thresholds for the claims-based measures to maintain the same distribution by points based on data from the April 2025 refresh.
To a review a copy of the updated Five -Star Technical User Guide - go to the link below: Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide July 2025
March 18, 2025
Congress Enacts six-month Medicare telehealth waiver extension for OT
On Friday, Congress approved a government funding package that included a 6-month extension of current Medicare telehealth waivers, now set to expire on September 30, 2025. These waivers, which were previously set to end on March 31, 2025, would have significantly reduced telehealth access for Medicare beneficiaries, including occupational therapy (OT) services. However, the package did not address the Medicare Physician Fee Schedule (MPFS) cuts that took effect in January.
There is strong bipartisan support in Congress to extend telehealth waivers. A 2-year extension for therapy telehealth was included in a healthcare package last December, but the package was derailed due to unrelated issues. The American Occupational Therapy Association (AOTA) continues to lobby for permanent telehealth provider status for occupational therapy practitioners (OTPs) and for extending waivers until a final policy is implemented.
To review a copy of the original article by Andy Bopp go to: Congress enacts six-month Medicare telehealth waiver extension for OT | AOTA