Now Available – AHCA Summary of FY26 SNF Proposed Payment Rule

The Centers for Medicare and Medicaid Services (CMS) last week issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2026 update. AHCA has reviewed the proposed rule and developed a summary outlining key provisions and impacts on members. Please note this is for members only and requires an AHCA/NCAL log-in to view.

As a reminder, the proposed rule:

• Would increase SNF PPS rates by 2.8%, or approximately $997 million, beginning October 1, 2025. This is based on the proposed SNF market basket increase of 3.0%, plus a 0.6% market basket forecast error adjustment, and a negative 0.8% productivity adjustment.
• Includes updates to PDPM ICD-10 code mappings and the SNF Quality Reporting Program. There were no proposed changes to the SNF Value-Based Purchasing Program for FY26, but future year changes are proposed for comment.
• Includes a request for information (RFI) for streamlining regulations and reducing administrative burdens. In every Medicare payment rule issued last week, CMS announced this RFI to comply with President Trump’s Executive Order “Unleashing Prosperity Through Deregulation.”

The proposed changes are detailed in the AHCA summary. Overall, we are encouraged by the proposed rule and look forward to submitting comments by June 29, 2025.

Please contact Martin Allen with any questions.

Clinical Update from KHCA Consultant Linda Farrar

In this month’s Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) Newsletter, much of the education provided centered around the fact that April is “Alcohol Awareness Month”. So what could that have to do with nursing homes anyway? They point out that this is a good time to “raise awareness and understanding of alcohol use and misuse”, which is a primary focus related to Substance Use Disorder, in the pending revisions to Appendix PP which are currently scheduled for April 28^th (THIS MONTH). Advice may be prepare for the changes, but please don’t hold your breath in case they extend the date again then perhaps make some revisions to the revisions. READ MORE

Members Only Nurse Advisory Committee (NAC) and Facility Standards Call – Friday, April 18, 2025 10:00AM - 11:00AM

Join us at 10:00AM where Cynthia Pendleton, Facility Standards VP and Linda Farrar, KHCA Clinical Consultant will review recent SNF survey findings followed by Nurse Advisory Committee President, Michelle Novotny to discuss Nursing Scholarships, hot topics, and the latest happenings.

Latest Survey Findings

Reflections

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Dr. Mehmet Oz Shares Vision for CMS

As Dr. Mehmet Oz completes his first week as the 17th Administrator of the Centers for Medicare & Medicaid Services (CMS), he is sharing his agenda and vision for the agency. A cardiothoracic surgeon and former host of an award-winning TV show, he now leads the largest agency under the Department of Health and Human Services (HHS), with a $1.7 trillion budget, tasked with delivering health outcomes for more than 160 million people. READ MORE

House Passes "Budget Blueprint" With Implied Medicaid Spending Cuts

McKnight’s Senior Living (4/14, Bonvissuto) reports the House on Thursday "narrowly passed a budget blueprint that implies big spending cuts for Medicaid." The NCAL "told McKnight’s Senior Living that one in five assisted living residents relies on Medicaid, and any reductions would threaten optional Medicaid benefits, such as home- and community-based waiver programs." Additionally, the NCAL said, "States could be forced to further restrict eligibility or cap the number of individuals who can access this benefit, which would reduce choices and extend waiting lists for seniors and their families. Congress must protect seniors on Medicaid and support the entire long-term care continuum so individuals can access the care they need where and when they need it." 

"Abrupt" CMS Termination Notices For Medicaid, Medicare Certification Of Nursing Homes On SFF List Have Surged Since Late February

Skilled Nursing News (4/11, Stulick) reported "Abrupt termination notices related to Medicaid and Medicare certification for nursing homes on the Special Focus Facilities (SFF) list have picked up dramatically as of late February, often occurring without warning or giving facilities the chance to demonstrate improvement." According to the story, "Attorneys familiar with the SFF process say turnover and reduction in the Centers for Medicare and Medicaid Services (CMS) staff may have something to do with the sudden termination notices." 

A Message from the President & CEO Linda MowBray: Our Kansas Commitment

WE DID IT!!!

Governor Kelly Signs Bipartisan Budget Bill

Nursing Home rebase, inflation and $20 per day add-on approved for FY26

Governor Laura Kelly has signed the state’s budget, Senate Bill 125, which allocates funding for Fiscal Years 2025, 2026, 2027, and 2028.

Although she did veto some of the measures in the bill, nursing home funding was not touched.

What that means for us is that on July 1, 2025 (the start of FY26), providers will see that their rates have been rebased using cost years 22-24 with an inflation factor calculated to the midpoint of FY26 (Dec. 31, 2025) and a $20 per day per Medicaid resident add-on.

Governor Kelly did express concerns about the financial impact of the bill; however, our rates are safe for another year.

“While I appreciate the bipartisan effort that went into crafting this bill, I remain concerned about the long-term fiscal impact this budget will have on our ability to invest in programs and services that Kansas families rely on, given that this budget will put the state in the red by Fiscal Year 2028,” Governor Laura Kelly said. “I am also concerned that the Legislature will adjourn before the release of Consensus Revenue Estimates, meaning we won’t fully understand the fiscal impact of this budget until after the Legislature has left town.”

Next steps for Medicaid rates: KHCA will be working with LeadingAge Kansas and KACE to discuss what changes we want to work with KDADS to remake the NF rate methodology including incentives ahead of next session and see how we can get as close to 100% cost reimbursement as possible without continuously going back to ask the Legislature for additional appropriations each year.

There will be a special Legislative committee meeting this summer where we will be able to discuss our ideas with key legislators and draft a funding bill prior to next year’s session. Additionally, we will be discussing the IDR process and transparency concerns.

Thank you for trusting us to be your voice in the legislature. As always, I am grateful for the opportunity to serve you.

Linda MowBray, President/CEO

lmowbray@khca.org

(785) 267-6003

CMS proposes 2.8 percent skilled nursing pay raise for 2026

Skilled nursing providers would see a 2.8% raise next fiscal year, or $196.5 million according to a proposed pay rule issued by the Centers for Medicare & Medicaid Services Friday. READ MORE

Also reported by Skilled Nursing News

CMS Finalizes Medicare Advantage Policy & Payment Rules

On Friday, April 4, the Centers for Medicare and Medicaid Services (CMS) issued the Contract Year 2026 Medicare Advantage and Medicare Part D Policy and Technical Changes final rule , which establishes key MA policies in the upcoming year and on Monday, April 7 per the statutory deadline, the Calendar Year 2026 MA Rate Announcement, which sets payment rates for contract year 2026. AHCA/NCAL is still reviewing the rules in detail but has developed a brief summary of each as it pertains to long term and post-acute care. (Please note that a member log-in is required to view the summary.)

MA Policy and Technical Changes

The final rule is primarily finalizing the required provisions related to the implementation of the Inflation Reduction Act. CMS did finalize some key provisions, including:

• Closing MA Appeals Loopholes
• Limiting the Reopening of MA Hospital Admission Decisions
• Non-Allowable Special Supplemental Benefits for the Chronically Ill
• Improvements to Care for Duals

The rule does not include certain provisions such as health equity analysis of utilization management policies, further clarifications on MA plans use of internal coverage criteria, requirements of Medicare and Medicaid coverage of anti-obesity medications, and ensuring fair access to MA services, by establishing guardrails on artificial intelligence.

MA Payment Rule

Medicare Advantage base rates are increasing by 5.06%. CMS is also completing the phase-in of the new risk adjustment model. More information about both of these is available in the AHCA/NCAL MA summary.

Please contact AHCA/NCAL’s Nisha Hammel with any questions regarding the MA rules.

New CMS Administrator Delivers First Public Message

McKnight’s Long-Term Care News (4/11, Marselas) reports, "Mehmet Oz, MD, took to social media Thursday to deliver his first public message as administrator of the Centers for Medicare & Medicaid Services administrator, promising that the agency would promote ‘personalized solutions’ through efforts fueled by ‘curiosity, courage, competence and compassion.’" As part of "a related press release Thursday, CMS said the agency would work under its new leader to modernize Medicare, the Affordable Care Act Marketplaces and Medicaid." In a statement, AHCA/NCAL President and CEO Clif Porter said, "We appreciate President Trump and many lawmakers’ commitments to prevent cuts to Medicaid benefits as well as their noble intent to focus on fraud, waste, and abuse. But make no mistake – Medicaid financing tools, like provider assessments, are legitimate, long-standing programs that support the care that nursing home residents receive. Reductions in provider assessments are a reduction to seniors’ access to care in nursing homes, pure and simple." 

HHS May Soon Begin Slashing Regulations It Considers To Be Unlawful Or To Exceed Agency’s Authority, Memo Says

FierceHealthcare (4/10, Beavins, Muoio, Tong, 150K) reports, "Starting in 10 days," HHS "may begin slashing regulations it considers to be unlawful or to exceed the agency’s authority, according to a memorandum sent by the president on Wednesday." FierceHealthcare adds, "Experts speculated the memorandum could rapidly diminish the number of federal health care regulations on the books." 

Receive $1,000 to attain Age-Friendly Health Systems Recognition - Kansas 4M (Apply by April 30, 2025)

Kansas 4M Geriatrics Workforce Education Program is offering $1,000 for up to 30 sites to participate in an Age-Friendly Action Community and achieve Level 1 and Level 2 Age-Friendly Health Systems Recognition.

Your invitation to hear Howard Kurtz at Congressional Briefing

June 9-10, 2025 | Capital Hilton | Washington, DC

Join us for an insightful keynote by Howard Kurtz at Congressional Briefing. With decades of experience as a distinguished journalist, Kurtz offers invaluable perspectives on today’s media landscape.

As the host of Media Buzz on FOX News, Kurtz covers a broad range of topics, including politics, technology, business, and culture. He is also a regular guest on The O'Reilly Factor and Special Report, and previously hosted CNN’s Reliable Sources for 15 years. In addition, he has held prominent roles as the Washington bureau chief for Newsweek and The Daily Beast, and as a reporter for The Washington Post.

Beyond hearing from thought leaders like Howard Kurtz, Congressional Briefing provides a unique opportunity for you to engage directly with policymakers, share your stories, and advocate for the issues that affect long term care. Register today!

Do You Need to Demonstrate Gerontological Nursing Competency?

Save $200 through May 15, 2025 with promo code: GROWRNS

• Significantly boosts experienced LTC RNs gerontological nursing knowledge.
• 94% first time pass rate on the optional additional ANCC Board Certification Exam.
• Online 24/7 & flexible with up to 12 months to complete.

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Advantage Wound Certification Course

May 14 - 15, 2025

8:30 AM - 5:00 PM

Wichita, KS



Early Bird Members $279 | Early Bird Non-Members $319

** Until April 30th

Members: The Nurse Advisory Committee has approved 16 full scholarships from the Joan Hamel Scholarship Fund for KHCA/KCAL nurses to attend. Learn more here.

Become an Advantage Certified Wound Nurse with this In Person Course.

Click here to learn more.

Webinar: Falls & Accidents

4/15/25 - 1:30PM - 2:30PM

Click here for more details.

Advanced Concepts for Operators - Assisted Living

Lunch and Learn

4/17/25 - 9:15AM - 3:30PM

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Assisted Living Conference

4/25/25 - 8:30AM - 4:00PM

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Advantage Wound Care Certification Course

5/14/25 & 5/15/25 - 8:30AM - 5:00PM

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Click here for more details about the scholarship.

Nurse Leadership Conference

6/25/25 & 6/26/25

Click here for more details.