Medicare Updates Payment Policies for Inpatient Rehabilitation and Skilled Nursing Facilities Effective October 1

August 5, 2026

The Top Line: Speech-language pathology services are critical elements of patient care in IRFs and SNFs. Starting on October 1, 2026, inpatient rehabilitation facilities and skilled nursing facilities will see payment increases for speech-language pathology and other services. CMS is also considering feedback about targeted payment reductions and changing clinical categories.

Each year, as required by law, the Centers for Medicare & Medicaid Services (CMS) updates payment policies for the various settings where Medicare beneficiaries receive care. This year, inpatient rehabilitation facilities and skilled nursing facilities (IRFs and SNFs, respectively) will see payment increases in federal fiscal year 2027 (FY 2027). The policies finalized in this rule are effective for dates of service on or after October 1, 2026.

ASHA continues to monitor the implementation of the Patient Driven Payment Model (PDPM) in SNFs and CMS efforts to align IRF payments with PDPM in the future.

SNF Regulatory Updates

Payment Rates

CMS finalized an increase to SNF prospective payment system rates of 2.4%. The per diem payment rate for speech-language pathology services in FY 2027 is $28.93 for SNFs in urban locations and $36.44 for SNFs in rural locations. These are modest increases from the calendar year 2026 rates.

Technical Updates to the PDPM ICD-10 Mappings

CMS received feedback from stakeholders requesting the addition of several International Classification of Diseases (ICD) 10 codes that trigger a speech-language pathology comorbidity payment, including R13.11 (Dysphagia, oral phase), R13.12 (Dysphagia, oropharyngeal phase), R13.13 (Dysphagia, pharyngeal phase), R13.14 (Dysphagia, pharyngoesophageal phase), and R13.19 (Other dysphagia). CMS said it would consider this feedback.

Policies to Address Case Mix Creep Under PDPM

Since the implementation of PDPM in 2020, CMS has monitored cost, payment, and service delivery to ensure payments to SNFs remain accurate. It has noted service delivery reductions across the board, particularly in therapy.

While some of this reduction was expected since payment is no longer driven by the amount of therapy provided, the significant decrease has exceeded CMS’ expectations. It has implemented across-the-board payment reductions to SNFs since PDPM implementation to address these concerns. However, CMS also requested information on the possibility of implementing payment reductions targeted at specific service areas, such as speech-language pathology services.

The ASHA Advocacy team strongly opposed payment reductions targeted at speech-language pathology services in our comments to CMS earlier this year. CMS did not finalize any policies for FY 2027 and said it will consider the feedback it received in potential future rulemaking.

SNF Quality Reporting Program (QRP) Updates

CMS is finalizing the removal of two measures from the SNF QRP beginning in FY 2028:

COVID-19 Vaccination Coverage Among Healthcare Personnel; and
COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date.

CMS is finalizing the revised data submission timeframe from 4.5 months to approximately 45 days, beginning with FY 2029. CMS is revising this timeframe to provide more timely publicly available data.

CMS also finalized a requirement for all SNFs to submit Minimum Data Set data for all SNF residents receiving covered skilled care, regardless of payer.

CMS indicated interest in potentially adopting a measure on the topic of advanced care planning in future years.

IRF Regulatory Updates

Payment Rates

CMS will increase payments to IRFs by 2.3% in FY 2027.

Initiation of Therapy Services

CMS finalized a policy that would require IRFs to initiate all (not just some) therapy evaluations and/or treatments within 36 hours from midnight on the day of admission.

Request for Information Regarding Future IRF Payment Reform

CMS included a request for information (RFI) on the possibility of modifying the clinical categories and comorbidities that drive payments to IRFs and align them with changes made under PDPM and the home health prospective payment system, the Patient Driven Groupings Model (PDGM).

ASHA Advocacy raised concerns about making such substantial changes without more detail and stakeholder engagement in our comments to CMS earlier this year. Because this was an RFI, CMS did not finalize any changes and stated it would consider the feedback in potential future rulemaking.

IRF Quality Reporting Program (QRP) Updates

As with the SNF QRP, CMS is finalizing the revised data submission timeframe from 4.5 months to approximately 45 days, beginning with FY 2029. This has the same goal of providing more timely publicly available data.

What This Means for SLPs

Speech-language pathology services are critical elements of patient care in IRFs and SNFs. Medicare believes these updates adequately cover costs to maintain access to care for beneficiaries. ASHA is committed to ensuring facilities use Medicare payments so that SLPs can serve their patients and beneficiaries can receive the care they need.