Federal Rulemaking · CMS-1843-F · Issued July 29, 2026

On July 29, 2026, CMS issued the Fiscal Year 2027 Skilled Nursing Facility Prospective Payment System Final Rule (CMS-1843-F). It finalizes a 2.4 percent net payment update, a 3.3 percent market basket increase minus a 0.9 percentage point productivity adjustment, worth an estimated $882.74 million to skilled nursing facilities, effective October 1, 2026. The proposed rule was published in the Federal Register on April 7, 2026 (2026-06674).

The FY2027 dial: where 2.4 percent comes from

Two inputs set the needle. CMS starts with the SNF market basket, then subtracts the statutory productivity adjustment. For FY2027, that arithmetic lands at 2.4 percent, which CMS estimates at $882.74 million in aggregate Part A payments beginning October 1, 2026.

From proposal to effective date

The bigger story: MDS for every payer

Today, the MDS assessment cadence that drives PDPM payment is built around Medicare Part A stays. The FY2027 final rule changes the trajectory: CMS finalized the path toward requiring MDS assessments for all covered skilled residents regardless of payer. Once the mandate phases in, Medicare Advantage and Medicaid skilled stays move onto federal assessment workflows, with the completion, accuracy, and submission discipline that implies.

The practical consequence is a volume question. An MDS coordinator team staffed against Part A census will face an assessment load that reflects the facility's entire covered skilled population. For buildings where Medicare Advantage penetration is high, the delta between today's assessment volume and the all-payer future is the planning number that matters, and it is knowable now from your own census mix.

Operator to-do list

1. Load the 2.4 percent update into your FY2027 Medicare Part A rate models and cash forecasts before October 1, 2026, using the final wage index and PDPM tables from CMS-1843-F.
2. Inventory MDS volume by payer. Count current PPS assessments against your full covered skilled census, and flag the Medicare Advantage and Medicaid stays that are not on a federal assessment schedule today.
3. Size MDS coordinator capacity against an all-payer assessment load. Hiring and training lead time for RN assessment coordinators is measured in months, so start the math before the phase-in dates land.
4. Audit your EHR and MDS submission configuration for non-Part A stays: payer flags, assessment scheduling logic, and transmission settings that assume Part A only will need rework.
5. Brief managed care contracting. All-payer MDS data will sit next to MA plan payment terms, so renegotiations should anticipate plans referencing federal assessment data.
6. Track CMS's phase-in guidance. Watch subsequent rulemaking and MDS technical specifications for the mandate's schedule, and assign an owner to monitor them.