The Centers for Medicare & Medicaid Services recently announced the Calenda
The proposed 4.33% increase in MA payments reflects adjustments in benchmark rates, risk scores, and other factors. This adjustment presents opportunities for SNFs to negotiate better contract terms with MA plans while ensuring alignment with updated reimbursement structures.
CMS continues refining its risk adjustment methodology, impacting how payments are calculated based on patient health conditions. SNFs must enhance their documentation and coding practices to accurately reflect patient acuity levels, ensuring appropriate reimbursement and minimizing potential underpayments.
As CMS emphasizes value-based care, SNFs participating in MA plans should expect increased scrutiny on quality metrics. Facilities should prioritize performance improvement initiatives, patient outcome tracking, and staff training to meet evolving quality benchmarks.
With payment increases come enhanced oversight and regulatory requirements. SNFs must stay up to date with evolving compliance standards, ensuring adherence to billing guidelines, medical necessity documentation, and patient care coordination requirements.
After a modest rate reduction in 2025, this proposed increase—amounting to $21 billion in additional payments—aims to strengthen the Medicare Advantage program while maintaining access to high-quality care. If finalized, rate adjustment may ease financial strain on MA plans, creating a more favorable environment for providers.
We can assist skilled nursing facilities with the following:
The proposed rate hike is a welcome development for the skilled nursing sector, particularly as providers navigate financial challenges and rising care complexities. While the increase is not as substantial as past adjustments—such as the 8.4% post-pandemic boost—it signals a shift toward improved financial support for MA plans and their contracted providers.
If approved, this increase could create better reimbursement opportunities for SNFs, ensuring they have the resources to continue delivering high-quality care. As the industry awaits finalization, nursing home advocates will continue pushing for adjustments that accurately reflect the growing acuity needs of their residents.
As these changes unfold, strategic financial planning will be crucial for SNFs to maximize revenue and ensure financial sustainability.
If you need support navigating these updates, contact us today.