Medicare Issues Proposed Acute and Post-Acute Payment Rules for 2026

Each year, the Medicare program proposes updates to payment rates, quality reporting programs, and other policies for each practice setting. Recently it issued proposed updates for acute care hospitals [PDF] (including long-term care hospitals (LTCHs), skilled nursing facilities (SNFs) [PDF], and inpatient rehabilitation facilities (IRFs) [PDF]. Each proposal is open for public comment through June 10, 2025, and ASHA is analyzing the rules to develop comments. Final rules will likely be issued in August for implementation on October 1, 2026.

These proposed rules are significantly shorter compared to rules issued in previous years. There are not many provisions with a direct link to the provision of audiology or speech-language pathology services. Below is a summary of each proposed rule.

Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals and LTCHs

Payment rates to acute care hospitals will increase by 2.4% in fiscal year (FY) 2026, which the Centers for Medicare & Medicaid Services (CMS) estimates will increase payments to this sector by $4 billion. Payments for LTCHs will increase by 2.6% ($52 million) next fiscal year.

For the first time, CMS proposes to require Medicare Advantage (MA) plans to report quality data associated with two measures in the Hospital Inpatient Quality Reporting (IQR) Program, which will help stakeholders gain a better understanding of the experience of care for Medicare patients who elect to be covered under a MA plan. These measures are:

• Hospital-Level, Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA)
• Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Acute Ischemic Stroke Hospitalization with Claims-Based Risk Adjustment for Stroke Severity

In addition, it is removing four measures under the IQR:

• Hospital Commitment to Health Equity
• COVID-19 Vaccination Coverage among Health Care Personnel
• Screening for Social Drivers of Health
• Screen Positive Rate for Social Drivers of Health

CMS also proposes to remove four measures associated with social determinants of health (SDOH) under the LTCH quality reporting program (QRP).

Resource: CMS IPPS Fact Sheet

Skilled Nursing Facility Prospective Payment System (SNF PPS)

CMS proposes to increase payments to SNFs by $196.5 million (2.8%) in FY 2026.

CMS also proposes to remove the health equity adjustment associated with the SNF value-based purchasing (VBP) program and remove the four SDOH measures from the SNF QRP (living situation, utilities, and two items for food). It is also seeking feedback on potential future measures for the SNF QRP associated with nutrition, delirium, interoperability and well-being.

Resource: CMS SNF PPS Fact Sheet

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)

CMS proposes to update payment rates to IRFs by 2.6% in FY2026, an increase in the standard payment amount to $19,364.

It will remove two measures related to COVID-19 vaccination and the four SDOH measures from the IRF QRP. It is also seeking feedback on potential future measures for the IRF QRP associated with nutrition, delirium, interoperability and well-being.

Resource: CMS IRF PPS Fact Sheet

Questions?

ASHA provides extensive resources related to Medicare coverage and payment. For questions, please contact ASHA’s health care and education policy team at reimbursement@asha.org.