LTC Clarified: Weekly News, Insights & Connections

Medicaid Case Mix Index Under PDPM:

What LTC Facilities Need to Know

As of October 1, 2025, the nationwide transition away from RUG-based Medicaid systems marks a major shift for long-term care. With more states moving to PDPM-based methodologies—and many adopting Nursing Component–only CMI calculations—facilities are navigating a very different landscape. The shift brings new opportunities, improved accuracy in capturing resident acuity, and a stronger emphasis on clinical documentation as compared to legacy case-mix models. But it also means facilities must elevate MDS processes to ensure Medicaid CMI truly reflects the medical, cognitive, and behavioral needs of their residents. Let’s break down the current environment with key strategies facilities should focus on right now.

Q: A resident tells you a personal item is missing. What steps should be taken?

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DECEMBER: Check out these upcoming December webinars!

SNF Provider Preview Reports – Now Available

Because of the lapse in federal appropriations, scheduled data refreshes and other routine updates were temporarily paused. With the resumption of government operations on November 13, these updates are now being released. The SNF Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on the compare tool on Medicare.gov and the Provider Data Catalog (PDC) during the January 2026 release.

• Data contained within the Provider Preview Reports are based on quality assessment data submitted by SNFs from Quarter 2, 2024 through Quarter 1, 2025.
• The COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure and CDC COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure reflect data from Quarter 1, 2025.
• The Influenza Vaccination Coverage Among Healthcare Personnel measure from the Centers for Disease Control and Prevention (CDC) reflect data from Quarter 4, 2024 through Quarter 1, 2025.
• The claims-based measures are based on data from Quarter 4, 2022 through Quarter 3, 2024.
• The SNF Healthcare-Associated Infections (HAI) measure reflect data from Quarter 4, 2023 through Quarter 3, 2024.

Providers have until December 17, 2025, to review their performance data. Only updates/corrections to the underlying assessment data before the final data submission deadline will be reflected in the publicly reported data on Medicare.gov and PDC. If a provider updates assessment data after the final data submission deadline, the updated data will only be reflected in the Facility-Level Quality Measure (QM) report and Patient-Level QM report. Updates submitted after the final data submission deadline will not be reflected in the Provider Preview Reports or on Medicare.gov. However, providers can request a CMS review of their data during the preview period if they believe the displayed quality measure scores within their Provider Preview Reports are inaccurate. For questions related to accessing your facility’s Provider Preview Report, please contact the iQIES Service Center by email at iqies@cms.hhs.gov or call 1-800-339-9313. For questions about SNF Quality Reporting Program (QRP) Public Reporting, please email SNFQRPPRQuestions@cms.hhs.gov.

Updated FY2028 SNF VBP Program Performance Standards

CMS identified a technical update for the Long Stay Hospitalization measure posted on August 4, 2025 at FY 2026 SNF Prospective Payment System (PPS) Final Rule . This update impacts the calculation of the achievement threshold and benchmark for the FY 2028 SNF VBP Program year.

Technical measure update: The Long Stay Hospitalization measure’s risk adjustment methodology uses functional status items from the Minimum Data Set (MDS) 3.0 for Nursing Homes. CMS updated the MDS 3.0 to replace Section G data elements with Section GG data elements starting at the beginning of FY 2024 (October 1, 2023). The measure’s risk adjustment methodology initially removed Section G items for a year because state timelines for implementing these elements varied, then added Section GG items into the risk adjustment model to replace Section G items once all states implemented Section GG.

Updates to FY 2028 Program year performance standards: To confirm the performance standards calculated using FY 2024 baseline period data – which had removed Section G elements – are as comparable as possible to the performance period measure results to be calculated using data from FY 2026 – which will use Section GG items – CMS is updating the performance standards for the FY 2028 Program year. The technical measure specifications utilizing Section GG items are described in more detail in the 2025 Nursing Home Compare Claims-Based Quality Measure Technical Specifications, available within the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User's Manual v17.0 .zip file package located on the CMS website.

Want to drive CMI results and nail MDS accuracy at your facility?

Achieving PDPM Success Part 1 and Part 2 On Demand Webinars can help!