CMS Issues Final Rules for Skilled Nursing and Inpatient Rehabilitation Facilities

August 19, 2025

The Centers for Medicare & Medicaid Services (CMS) updated Medicare payment policies for skilled nursing and inpatient rehabilitation facilities. These policies will go into effect on October 1, 2025.

ASHA comments on the proposed rules earlier this year focused on quality reporting and data collection associated with social determinants of health (SDOH).

Skilled Nursing Facility (SNF) Policy Updates

Payment

Payments to SNFs will increase by 3.2%, or $1.16 billion, in fiscal year (FY) 2026.

SNF Value-Based Purchasing (VBP) Program

The SNF VBP Program is a pay-for-performance initiative in which CMS withholds 2% of Medicare fee-for-service Part A payments from SNFs and redistributes them as incentives based on performance. This year, consistent with changes across other inpatient and post-acute quality reporting programs, CMS is removing the program’s Health Equity Adjustment from its scoring methodology, despite ASHA’s support for it. CMS is also finalizing a new reconsideration process, allowing SNFs to appeal initial decisions on review and correction requests before any affected data is made public.

SNF Quality Reporting Program (QRP)

The SNF QRP is a pay-for-reporting program in which SNFs that fail to meet reporting requirements face a 2-percentage-point reduction in their Annual Payment Update (APU). While ASHA strongly supported including SDOH measures, CMS will remove reporting requirements for four data elements: one on living situation, two on food, and one on utilities.

CMS also summarized feedback on several Requests for Information (RFIs) from the FY 2026 SNF PPS proposed rule, including future measure concepts related to delirium, interoperability, nutrition, and well-being. ASHA’s comments [PDF], which were included in CMS’ summary, highlighted the value of speech-language pathology services to maintain nutrition and hydration for individuals with swallowing and feeding disorders.

Inpatient Rehabilitation Facility (IRF) Policy Updates

Payment

CMS updated payments to IRFs by 2.6% in 2026, resulting in a spending increase of $340 million.

IRF Quality Reporting Program (QRP)

The IRF QRP is a pay-for-reporting program in which IRFs that fail to meet reporting requirements are subject to a 2-percentage-point reduction in their Annual Increase Factor. CMS is removing two measures: (1) COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) and (2) COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date.

CMS is also removing four SDOH standardized patient assessment data elements from the IRF-PAI—one on living situation (R0310), two on food (R0320A and R0320B), and one on utilities (R0330)—for patients admitted on or after October 1, 2026. In addition, CMS is finalizing a new reconsideration process allowing IRFs to appeal determinations of noncompliance with QRP requirements.

In response to an RFI on future measures, CMS received feedback on topics such as interoperability, nutrition, delirium, and well-being. ASHA’s comments [PDF] emphasized the role of SLPs in maintaining nutrition for individuals with feeding and swallowing disorders and in assessing and treating delirium.

Background

CMS is required to update payment policies for each practice setting on an annual basis. ASHA continues to monitor these policies and comment on them, when appropriate, to ensure ASHA member interests are represented and patients maintain access to care.