Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027; Correction
This document corrects technical errors in the final rule that appeared in the July 31, 2026 Federal Register titled "Medicare Program; Prospective Payment System and Consolidat...
Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).
ACTION:
Final rule; correction.
SUMMARY:
This document corrects technical errors in the final rule that appeared in the July 31, 2026
Federal Register
titled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027.”
DATES:
This correction is effective October 1, 2026.
FOR FURTHER INFORMATION CONTACT:
Heidi Magladry, (410) 786-6034.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2026-15562 of July 31, 2026 (91 FR 48588 through 48654), there were a number of technical errors that are identified and corrected in this correcting document.
II. Summary of Errors
A. Skilled Nursing Facility (SNF) Prospective Payment System (PPS)
Payments under the SNF PPS are adjusted for several factors, including a wage index based on data collected for the Inpatient Prospective Payment System (IPPS). Under our methodologies as finalized in the FY 2027 Inpatient Prospective Payment System, Long Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) final rule, we exclude hospitals that have subsequently converted to rural emergency hospitals (REHs) from certain data and calculations used in the IPPS rate setting. Specifically, we stated that we exclude REHs, including hospitals that subsequently became REHs after the period from which the data were taken for purposes of developing the Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights for FY 2027 (91 FR 49672) and from the calculation of the standardized amount (91 FR 50370). In addition, we stated that any hospital that is designated as a REH by 7 days prior to the publication of the preliminary wage index public use file (PUF) is excluded from the calculation of the wage index. We inadvertently treated a current IPPS hospital as a hospital that had converted to REH status, thereby erroneously excluding its data from the MS-DRG relative weight calculation and the wage index (CMS Certification Number 250078). Therefore, we restored the applicable data for this hospital for these and other rate setting calculations, which required the recalculation of the SNF wage index budget neutrality factor, unadjusted SNF PPS Federal per diem rates, and the case-mix adjusted SNF PPS rates, as discussed further in section IV. of this correcting document.
On pages 48594, 48596 through 48597, 48599, 48601, and 48602, a technical error in the calculation of the final FY 2027 SNF PPS wage indexes required us to recalculate the wage index budget neutrality factor for (1) the unadjusted SNF PPS Federal per diem rates provided in Tables 3 and 4; (2) the case-mix adjusted SNF PPS rates provided in Tables 5 and 6; (3) the wage index budget neutrality factor; (4) the computed example total; (5) the PDPM case-mix adjusted rate computation example and wage index adjusted rate computation example in Tables 8 and 9, respectively; and (6) the adjusted rate computation example in Table 10. The numbers in the impact analysis provided on pages 48645 through 48646 in Table 25 are not affected at the displayed level. Further discussions of these errors are found in section IV. of this notice.
B. Summary of Errors and Corrections Posted on the CMS Website for the SNF Wage Index
After the FY 2027 SNF PPS final rule was published, we identified issues in the SNF wage index file. As discussed in the FY 2027 SNF PPS final rule (91 FR 48597 through 48600), in developing the wage index to be applied to SNFs under the SNF PPS, we use the updated, pre-reclassified, hospital inpatient PPS (IPPS) wage data, exclusive of the occupational mix adjustment, omitting the rural floor. For FY 2027, the updated wage data are for hospital cost reporting periods beginning on or after October 1, 2022, and before October 1, 2023 (FY 2023 cost report data), as discussed in the final rule entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care
( printed page 61783)
Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; Other Policy Changes; and Adoption of Updated Versions of Certain Health Information Technology Standards”(91 FR 49570) (hereinafter referred to as the FY 2027 IPPS/LTCH PPS final rule).
C. SNF Quality Reporting Program
On pages 48589, 48640, 48641, 48642, 48643, 48644, 48646, 48647, 48652, we are correcting the calculations for skilled nursing facilities used in the final rule. We inadvertently reflected the MEAN Bureau of Labor Statistics (BLS) wage and not the MEDIAN BLS wage, which will impact the burden numbers.
III. Waiver of Proposed Rulemaking
Section 1871(b)(1) of the Social Security Act (the Act) requires the Secretary to provide for notice of a proposed rule in the
Federal Register
and provide a period of not less than 60 days for public comment. In addition, section 1871(e)(1)(B)(i) of the Act mandates a 30-day delay in effective date after issuance or publication of a rule. Section 1871(b)(2)(C) of the Act provides an exception from the notice and 60-day comment period and delay in effective date requirements of the Act under the good cause standard set forth in 5 U.S.C. 553(b)(B). Section 1871(e)(1)(B)(ii) of the Act provides an exception from the delay in effective date requirements of the Act as well. Section 553(b)(B) authorizes an agency to dispense with normal notice and comment rulemaking procedures for good cause if the agency makes a finding that the notice and comment process is impracticable, unnecessary, or contrary to the public interest, and includes a statement of the finding and the reasons for it in the rule. In addition, section 1871(e)(1)(B)(ii) of the Act allows the agency to avoid the 30-day delay in effective date where the waiver is necessary to comply with statutory requirements or such delay is contrary to the public interest and the agency includes in the rule a statement of the finding and the reasons for it.
We believe that this final rule correction does not constitute a rule that would be subject to the notice and comment or delayed effective date requirements. This document merely corrects technical and typographical errors in the preamble, and tables referenced in the FY 2027 SNF final rule but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, the corrections made through this document are intended to resolve inadvertent errors so that the FY 2027 SNF final rule accurately reflects the policies adopted therein.
In addition, even if this were a rule to which the notice and comment procedures and delayed effective date requirements applied, we find that there is good cause to waive such requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the final rule or delaying the effective date would be contrary to the public interest because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2027 SNF PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply correctly implementing the methodologies and policies that we previously proposed, requested comment on, and subsequently finalized. This final rule correction is intended solely to ensure that the FY 2027 SNF PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive the notice and comment and effective date requirements.
1. On page 48589, top of the page, TABLE 1: ESTIMATED COST AND BENEFITS is corrected to read as follows:
2. On page 48594, middle of the page, TABLE 3: FY2027 UNADJUSTED FEDERAL RATE PER DIEM—URBAN is corrected to read:
( printed page 61784)
3. On page 48594, middle of the page, TABLE 4: FY2027 UNADJUSTED FEDERAL RATE PER DIEM—RURAL is corrected to read:
4. On page 48596, top of page, TABLE 5: PDPM CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN is corrected to read:
( printed page 61785)
5. On page 48597, top of the page, TABLE 6: PDPM CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL is corrected to read:
6. On page 48599, third column (below Table 7), first partial paragraph, line 8, the figure “0.9989” is corrected to read “0.9988”.
7. On page 48601,
a. Third column, first partial paragraph, line 2, the figure “$23,413.26” is corrected to read “$23,412.69”.
b. Top of the page, TABLE 8: PDPM CASE-MIX ADJUSTED RATE COMPUTATION EXAMPLE is corrected to read:
( printed page 61786)
8. On page 48601, middle of the page “TABLE 9: WAGE INDEX ADJUSTED RATE COMPUTATION EXAMPLE” is corrected to read:
9. On page 48602, top of the page, TABLE 10: ADJUSTED RATE COMPUTATION EXAMPLE is corrected to read:
( printed page 61787)
10. On page 48640,
a. Top of the page, TABLE 18: U.S. BUREAU OF LABOR AND STATISTICS' MAY 2024 NATIONAL OCCUPATIONAL EMPLOYMENT AND WAGE ESTIMATES is corrected to read as follows:
( printed page 61788)
b. Third column, second full paragraph,
(1) Line 8 the figure “$43.82” is corrected to read “$42.92”.
(2) Line 10 the figure “$525.84” is corrected to read “$515.04”.
(3) Line 10 the figure “$43.82” is corrected to read “$42.92”.
(4) Line 11 the figure “$7,831,860.96” is corrected to “$7,671,005.76”.
(5). Line 12 the figure “$525.84” is corrected to “$515.04”.
c. Bottom of page, the table titled “TABLE 19: ESTIMATED BURDEN REDUCTION ASSOCIATED WITH REMOVAL OF THE HCP COVID-19 VACCINE MEASURE BEGINNING WITH THE FY 2028 SNF QRP” is corrected to read as follows:
11. On page 48641,
a. Second column, first partial paragraph,
(1) Line 11, the figure “$78.16” is corrected to read” $74.97”.
(2) Line 13, the figure “$61.68” is corrected to read “$59.94”.
(3) Line 14,
(a) The figure “$94.64” is corrected to read “$90.00”.
(b) The figure “$78.16” is corrected to read “$74.97”.
b. Third column, first full paragraph,
(1) Line 6, the figure “$78.16” is corrected to read “$74.97.”
(2) Line 9, the figure “$580,416” is corrected to read “$556,727.22”.
(3) Line 10, the figure “$78.16” is corrected to read “$74.97”.
(4) Line 14,
(a) The figure “$38.97” is corrected to read “$37.38”.
(b) The figure “$580,416” is corrected to read “$556,727.22”.
c. Middle of the page, the table titled “TABLE 20: ESTIMATED BURDEN ASSOCIATED WITH OMB CONTROL NUMBER (CMS-10387) RELATED TO THE SNF QRP BEGINNING WITH THE FY 2028 SNF QRP” is corrected as follows:
d. Third column, third partial paragraph (under table 20), line 2,
(1) The figure “$8,412,277.12” is corrected to read “$8,227,732.98”.
(2) The figure “$564.81” is corrected to read “$552.42”.
e. Bottom of page, the table titled “TABLE 21: ESTIMATED BURDEN ASSOCIATED WITH SNF QRP BEGINNING WITH THE FY 2028 SNF QRP” is corrected as follows:
(1) Line 15, the figure “$78.16” is corrected to read “$74.97”.
(2) Line 19, the figure “$61.68” is corrected to read “$59.94”.
(3) Line 20,
(a) The figure “$94.64” is corrected to read “$90.00”.
(b) The figure “$78.16” is corrected to read “$74.97”.
b. Third column, first full paragraph,
(1) Line 15, the figure “$1,238,134.12” is corrected to read “$1,187,601.27”.
(2) Line 16,
(a) The figure “$78.16” is corrected to read “$74.97”.
(b) The figure “$83.13” is corrected to read “$79.74”.
(3) Line 17, the figure “$1,238,134.12” is corrected to read “$1,187,601.27”
c. Third column, second full paragraph,
(1) Line 15, the figure “$1,741,149.22” is corrected to read “$1,670,086.45”.
(2) Line 16,
(a) The figure “$78.16” is corrected to read “$74.97”.
(b) The figure “$116.90” is corrected to read “$112.13”.
(3) Line 17, the figure “$1,741,149.22” is corrected to read “$1,670,086.45”.
d. Third column, third full paragraph,
(1) Line 13, the figure “$2,979,283.34” is corrected to read “$2,857,687.72”.
(2) Line 14, the figure “$1,238,134.12” is corrected to read “$1,187,601.27”.
(3) Line 15,
(a) The figure “$1,741,149.22” is corrected to read “$1,670,086.45”.
(b) The figure “$200.03” is corrected to read “$191.87”.
(4) Line 16, the figure “$83.13” is corrected to read “$79.74”.
(5) Line 17, the figure “$116.90” is corrected to read “$112.13”.
13. On page 48643,
a. Top of the page, the table titled “TABLE 22: ESTIMATED BURDEN ASSOCIATED WITH OMB CONTROL NUMBER 0938-1140 (CMS-10387) RELATED TO THE SNF QRP BEGINNING WITH THE FY 2031 SNF QRP” is corrected to read as follows:
b. Third column, first partial paragraph,
(1) Line 17, the figure “$88.28” is corrected to read “$86.68”.
(2) Line 18, the figure “$61.68” is corrected to read “$59.94”.
(3) Line 19,
(a) The figure “$94.46” is corrected to read “$94.56”.
(b) The figure “$98.46” is corrected to read “$97.14”.
(4) Line 20, the figure “$94.64” is corrected to read “$90.00”.
(5) Line 21,
(a) The figure “$92.16” is corrected to read “$91.74”.
(b) The figure “$88.28” is corrected to read “$86.68”.
c. Third column, second full paragraph,
(1) Line 3, the figure “$85,066,753.66” is corrected to read “$83,524,991.02”.
(2) Line 4, the figure “$88.28” is corrected to read “$86.68”
(3) Line 6,
(a) The figure “$5,711.48” is corrected to read “$5,607.96”.
(b) The figure “$85,066,753.66” is corrected to read “$83,524,991.02”.
14. On page 48644,
a. Top of the page, the table titled “TABLE 23: ESTIMATED BURDEN ASSOCIATED WITH SUBMISSION OF MDS DATA ON ALL RESIDENTS ADMITTED FOR COVERED SKILLED CARE BEGINNING WITH THE FY 2031 SNF QRP” is corrected to read as follows:
( printed page 61790)
b. Third column, first partial paragraph under table 23,
(1) Line 2, the figure “$88,046,037.00” is corrected to read “$86,382,678.74”.
(2) Line 3, the figure “$5,911.51” is corrected to read “$5,799.83”.
c. Middle of the page, the table titled “TABLE 24: ESTIMATED BURDEN ASSOCIATED WITH SNF QRP PROPOSALS BEGINNING WITH THE FY 2031 SNF QRP” is corrected to read as follows:
15. Page 48646,
a. Second column, first partial paragraph:
(1) Line 4, the figure “$525.84” is corrected to read “$515.04”.
(2) Line 7, the figure “$7,831,860.96” is corrected to read “$7,671,005.76”.
(3) Line 8, the figure “$525.84” is corrected to read “$515.04”.
b. Second column, first full paragraph,
(1) Line 7, the figure “$38.97” is corrected to read “$37.38”.
(2) Line 9, the figure “$580,416.16” is corrected to read “$556,727.22”.
(3) Line 10, the figure “$78.16” is corrected to read “$74.97”.
16. Page 48647,
a. First column, first full paragraph after the heading “(1) Impacts for Submission of Three New MDS Items Beginning With the FY 2031 SNF QRP”,
(1) Line 5, “$1,238,134.12” is corrected to read “$1,187,601.27”.
(2) Line 6, “$78.16” is corrected to read “$74.97”.
b. Second column, first partial paragraph,
(1) Line 4, “$83.13” is corrected to read “$79.74”.
(2) Line 9, “$1,741,149.22” is corrected to read “$1,670,086.45”.
(3) Line 10, “$78.16” is corrected to read “$74.97”.
(4) Line 13, “$116.90” is corrected to read “$112.13”.
c. Second column, first full paragraph, line 6,
(1) The figure “$2,979,283.34” is corrected to read “$2,857,687.72”.
(2) The figure “$200.03” is corrected to read “$191.87”.
d. Third column, first partial paragraph,
(1) Line 5, “$85,066,753.66” is corrected to read “$83,524,991.02”.
(2) Line 6, “$88.28” is corrected to read “$86.68”.
(3) Line 9, “$5,711.48” is corrected to read “$5,607.96”.
e. Middle of the page, the table titled “TABLE 26: ESTIMATED IMPACTS FOR THE FY 2028 SNF QRP” is corrected to read as follows:
( printed page 61791)
f. Bottom of the page, the table titled “TABLE 27: ESTIMATED IMPACTS FOR THE FY 2031 SNF QRP” is corrected to read as follows:
17. Page 48652, bottom of the page,
a. The table titled “TABLE 32: ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED SAVINGS FOR THE CHANGES TO THE FY 2028 SNF QRP” is corrected to read as follows:
b. The table titled “TABLE 33: ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FOR THE CHANGES TO THE FY 2031 SNF QRP” is corrected to read as follows:
Liesl I. Fowler,
Executive Secretary to the Department, Department of Health and Human Services.
Use this for formal legal and research references to the published document.
91 FR 61782
Web Citation
Suggested Web Citation
Use this when citing the archival web version of the document.
“Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027; Correction,” thefederalregister.org (September 30, 2026), https://thefederalregister.org/documents/2026-19959/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities-updates-to-the-quali.
5 U.S.C. 553(b)(B)
www.bls.gov/oes/current/oes_stru.htm
