Federal and State News

Stay in the Know for

&

On July 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2026.

CMS Fact Sheet:

https://www.cms.gov/newsroom/fact-sheets/fy-2026-skilled-nursing-facility-snf-prospective-payment-system-final-rule-cms-1827-f

PDPM Transition Process Announced

Attention Pennsylvania Skilled Nursing Facilities!

Big changes are coming with the transition to the Patient-Driven Payment Model (PDPM), as outlined in the Notice of Final-Form Rulemaking from the Department of Human Services Office of Long-Term Living approved on May 14, 2025. Here's what you need to know:

Rates will be determined using a mix of the Nursing Clinical Category of PDPM and RUG-III during the transition.
RUG-III portion will be frozen based on an average of two quarters using the May 1st and August 1st, 2025, Picture Dates.
The transition will happen in four phases:

Phase 1 (April 2026 rates) – 25% PDPM | 75% RUG-III (Picture Date: 11/01/2025)
Phase 2 (July 2026 rates) – 50% PDPM | 50% RUG-III (Picture Date: 02/01/2026)
Phase 3 (October 2026 rates) – 75% PDPM | 25% RUG-III (Picture Date: 05/01/2026)
Phase 4 (January 2027 rates) – 100% PDPM (Picture Date: 08/01/2026)

What does this mean for your facility?

The May 1st and August 1st picture dates have become the most critical rate-setting dates since 2009! As August approaches, it is vital to ensure your community captures all services provided to residents in documentation and on the Minimum Data Set (MDS).

April 1, 2025

NOW AVAILABLE: Draft MDS 3.0 RAI User’s Manual version 1.20.1

The draft Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual version (v)1.20.1 is now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The MDS 3.0 RAI User’s Manual v1.20.1 will be effective beginning October 1, 2025.

This version of the MDS 3.0 RAI User’s Manual includes changes to Section A: Identification Information, including the removal of item A0800: Gender, addition of new item A0810: Sex, and removal of item A1250: Transportation. Section GG: Functional Abilities has been restructured to improve clarity for items GG0130: Self-Care and GG0170: Mobility and to align with similar guidance from other manuals. Changes to Section O: Special Treatments, Procedures, and Programs include the addition of new item O0390: Therapy Services, the revision of item O0400: Therapies, and the removal of item O0420: Distinct Calendar Days of Therapy. Guidance has been added for Section R: Health-Related Social Needs starting on page R-1, which includes new items R0310: Living Situation, R0320: Food, R0330: Utilities, and R0340: Transportation. Various minor alignments, clarifications, and corrections have been implemented throughout; specifics can be found in the included chapter/section change tables following the guidance.

SNF QRP Measure Calculations and Reporting User’s Manual V7.0, Change Table, Risk Adjustment Appendix File, Imputation Appendix File, and HCC ICD-10 Crosswalks – Now Available

The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Measure Calculations and Reporting User's Manual v7.0 and accompanying files are now available. These materials serve as an update to the specifications used to calculate quality measures that are included in the SNF QRP and will be effective beginning October 1, 2025.

The accompanying SNF QRP Measure Calculations and Reporting User’s Manual Change Table Version 7.0 provides a summary of changes between Version 7.0 and Version 6.0 of the SNF QRP Measure Calculations and Reporting User’s Manual. Changes include a modification to the function measures based on the removal of item O0400 in the MDS 3.0 version 1.20.1. Furthermore, the Risk Adjustment Appendix File for the SNF QRP Measure Calculations and Reporting User’s Manual Version 7.0 contains coefficient values used to calculate the risk-adjusted quality measures. The Crosswalks of Hierarchical Condition Categories (HCC) to International Classification of Diseases (ICD)-10 codes are used in the risk-adjustment models for the Discharge Self-Care, Discharge Mobility, and Discharge Function Score measures and remain unchanged since V6.0. Lastly, the Imputation Appendix File for the SNF QRP Measure Calculations and Reporting User’s Manual Version 7.0 contains imputed coefficients used to calculate the risk-adjusted Discharge Function Score measure.

For more information, please visit https://www.cms.gov/medicare/quality/snf-quality-reporting-program/measures-and-technical-information

Quality Reporting Program: Non-Compliance Letters for FY 2026 APU

The Centers for Medicare & Medicaid Services (CMS) is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2024, which will affect their FY 2026 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into facilities’ CASPER folders in QIES, for Hospices and into facilities’ My Reports folders in the Internet Quality Improvement and Evaluation System (iQIES), for IRFs, LTCHs and SNFs, on July 21, 2025. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 26, 2025.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the appropriate QRP webpage:

MDS 3.0 Quality Measures User's Manual v17.0 Effective

January 1, 2025 and Associated User Manual Files – Updated Claims and SNF QRP Measure Materials

https://www.cms.gov/medicare/quality/nursing-home-improvement/quality-measures

Recommend for downloading from site: mds-qm-users-manual-v170-effective-1-1-2025-and-associated-user-manuals.zip

An updated .zip file for the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User's Manual v17.0 is now available. This .zip file package contains the updated 2025 Nursing Home Compare Claims-Based Quality Measure Technical Specifications and associated appendix and the updated Skilled Nursing Facility Quality Reporting Program (SNF QRP) Measure Calculations and Reporting User’s Manual V7.0 and associated risk adjustment and imputation appendix files. Specifically, the updated .zip file titled MDS 3.0 QM User's Manual v17.0 Effective 1-1-2025 and Associated User Manual Files.zip includes a complete set of six files:

The MDS 3.0 QM User’s Manual V17.0 contains detailed specifications for the MDS 3.0 QMs and includes a Notable Changes section that summarizes the major changes from MDS 3.0 QM User’s Manual V16.0.
The Risk Adjustment Appendix File for the MDS 3.0 Quality Measures User’s Manual accompanies the MDS 3.0 QM Manual v17.0 and contains the logistic regression coefficient values used to calculate the risk-adjusted quality measures. There are no coefficient changes to the Risk Adjustment Appendix File from v16.0 to v17.0 since specification updates did not significantly change the coefficient values.
Nursing Home Compare Claims-based Quality Measure Technical Specifications (Claims-based Measures Tech Specs 2025 Update June 2025) contains detailed technical specifications for all Nursing Home Claims-based Quality Measures.
Nursing Home Compare Quality Measures Technical Specifications Appendix (APPENDIX - Claims-based measures Technical Specifications updates June 2025) contains tables and appendices related to the Nursing Home Compare Claims-based Quality Measures.
The SNF QM User’s Manual V7.0 contains detailed specifications for all SNF QRP Quality Measures effective October 1, 2025.
The Risk Adjustment Appendix File for the SNF Quality Measures User’s Manual v7.0 contains coefficient values used to calculate the risk-adjusted quality measures.
The Imputation Appendix File for the SNF Quality Measures User’s Manual v7.0 contains imputed coefficients used to calculate the risk-adjusted Discharge Function Score measure.