Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027; Correction

Issuing agencies

Abstract

This document corrects technical errors in the final rule that appeared in the July 31, 2026 Federal Register titled "Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027."

Full Text

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<title>Federal Register, Volume 91 Issue 188 (Wednesday, September 30, 2026)</title>
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[Federal Register Volume 91, Number 188 (Wednesday, September 30, 2026)]
[Rules and Regulations]
[Pages 61782-61791]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-19959]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 413

[CMS-1843-CN]
RIN 0938-AV75


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Updates to the Quality 
Reporting Program for Federal Fiscal Year 2027; Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors in the final rule that 
appeared in the July 31, 2026 Federal Register titled ``Medicare 
Program; Prospective Payment System and Consolidated Billing for 
Skilled Nursing Facilities; Updates to the Quality Reporting Program 
for Federal Fiscal Year 2027.''

DATES: This correction is effective October 1, 2026.

FOR FURTHER INFORMATION CONTACT: Heidi Magladry, (410) 786-6034.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2026-15562 of July 31, 2026 (91 FR 48588 through 48654), 
there were a number of technical errors that are identified and 
corrected in this correcting document.

II. Summary of Errors

A. Skilled Nursing Facility (SNF) Prospective Payment System (PPS)

    Payments under the SNF PPS are adjusted for several factors, 
including a wage index based on data collected for the Inpatient 
Prospective Payment System (IPPS). Under our methodologies as finalized 
in the FY 2027 Inpatient Prospective Payment System, Long Term Care 
Hospital Prospective Payment System (IPPS/LTCH PPS) final rule, we 
exclude hospitals that have subsequently converted to rural emergency 
hospitals (REHs) from certain data and calculations used in the IPPS 
rate setting. Specifically, we stated that we exclude REHs, including 
hospitals that subsequently became REHs after the period from which the 
data were taken for purposes of developing the Medicare Severity 
Diagnosis-Related Group (MS-DRG) relative weights for FY 2027 (91 FR 
49672) and from the calculation of the standardized amount (91 FR 
50370). In addition, we stated that any hospital that is designated as 
a REH by 7 days prior to the publication of the preliminary wage index 
public use file (PUF) is excluded from the calculation of the wage 
index. We inadvertently treated a current IPPS hospital as a hospital 
that had converted to REH status, thereby erroneously excluding its 
data from the MS-DRG relative weight calculation and the wage index 
(CMS Certification Number 250078). Therefore, we restored the 
applicable data for this hospital for these and other rate setting 
calculations, which required the recalculation of the SNF wage index 
budget neutrality factor, unadjusted SNF PPS Federal per diem rates, 
and the case-mix adjusted SNF PPS rates, as discussed further in 
section IV. of this correcting document.
    On pages 48594, 48596 through 48597, 48599, 48601, and 48602, a 
technical error in the calculation of the final FY 2027 SNF PPS wage 
indexes required us to recalculate the wage index budget neutrality 
factor for (1) the unadjusted SNF PPS Federal per diem rates provided 
in Tables 3 and 4; (2) the case-mix adjusted SNF PPS rates provided in 
Tables 5 and 6; (3) the wage index budget neutrality factor; (4) the 
computed example total; (5) the PDPM case-mix adjusted rate computation 
example and wage index adjusted rate computation example in Tables 8 
and 9, respectively; and (6) the adjusted rate computation example in 
Table 10. The numbers in the impact analysis provided on pages 48645 
through 48646 in Table 25 are not affected at the displayed level. 
Further discussions of these errors are found in section IV. of this 
notice.

B. Summary of Errors and Corrections Posted on the CMS Website for the 
SNF Wage Index

    After the FY 2027 SNF PPS final rule was published, we identified 
issues in the SNF wage index file. As discussed in the FY 2027 SNF PPS 
final rule (91 FR 48597 through 48600), in developing the wage index to 
be applied to SNFs under the SNF PPS, we use the updated, pre-
reclassified, hospital inpatient PPS (IPPS) wage data, exclusive of the 
occupational mix adjustment, omitting the rural floor. For FY 2027, the 
updated wage data are for hospital cost reporting periods beginning on 
or after October 1, 2022, and before October 1, 2023 (FY 2023 cost 
report data), as discussed in the final rule entitled ``Medicare 
Program; Hospital Inpatient Prospective Payment Systems for Acute Care

[[Page 61783]]

Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment 
System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements 
for Quality Programs; Other Policy Changes; and Adoption of Updated 
Versions of Certain Health Information Technology Standards''(91 FR 
49570) (hereinafter referred to as the FY 2027 IPPS/LTCH PPS final 
rule).

C. SNF Quality Reporting Program

    On pages 48589, 48640, 48641, 48642, 48643, 48644, 48646, 48647, 
48652, we are correcting the calculations for skilled nursing 
facilities used in the final rule. We inadvertently reflected the MEAN 
Bureau of Labor Statistics (BLS) wage and not the MEDIAN BLS wage, 
which will impact the burden numbers.

III. Waiver of Proposed Rulemaking

    Section 1871(b)(1) of the Social Security Act (the Act) requires 
the Secretary to provide for notice of a proposed rule in the Federal 
Register and provide a period of not less than 60 days for public 
comment. In addition, section 1871(e)(1)(B)(i) of the Act mandates a 
30-day delay in effective date after issuance or publication of a rule. 
Section 1871(b)(2)(C) of the Act provides an exception from the notice 
and 60-day comment period and delay in effective date requirements of 
the Act under the good cause standard set forth in 5 U.S.C. 553(b)(B). 
Section 1871(e)(1)(B)(ii) of the Act provides an exception from the 
delay in effective date requirements of the Act as well. Section 
553(b)(B) authorizes an agency to dispense with normal notice and 
comment rulemaking procedures for good cause if the agency makes a 
finding that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and includes a 
statement of the finding and the reasons for it in the rule. In 
addition, section 1871(e)(1)(B)(ii) of the Act allows the agency to 
avoid the 30-day delay in effective date where the waiver is necessary 
to comply with statutory requirements or such delay is contrary to the 
public interest and the agency includes in the rule a statement of the 
finding and the reasons for it.
    We believe that this final rule correction does not constitute a 
rule that would be subject to the notice and comment or delayed 
effective date requirements. This document merely corrects technical 
and typographical errors in the preamble, and tables referenced in the 
FY 2027 SNF final rule but does not make substantive changes to the 
policies or payment methodologies that were adopted in the final rule. 
As a result, the corrections made through this document are intended to 
resolve inadvertent errors so that the FY 2027 SNF final rule 
accurately reflects the policies adopted therein.
    In addition, even if this were a rule to which the notice and 
comment procedures and delayed effective date requirements applied, we 
find that there is good cause to waive such requirements. Undertaking 
further notice and comment procedures to incorporate the corrections in 
this document into the final rule or delaying the effective date would 
be contrary to the public interest because it is in the public's 
interest for providers to receive appropriate payments in as timely a 
manner as possible, and to ensure that the FY 2027 SNF PPS final rule 
accurately reflects our policies. Furthermore, such procedures would be 
unnecessary, as we are not altering our payment methodologies or 
policies, but rather, we are simply correctly implementing the 
methodologies and policies that we previously proposed, requested 
comment on, and subsequently finalized. This final rule correction is 
intended solely to ensure that the FY 2027 SNF PPS final rule 
accurately reflects these payment methodologies and policies. 
Therefore, we believe we have good cause to waive the notice and 
comment and effective date requirements.

IV. Correction of Errors

    In FR Doc. 2026-15562 of July 31, 2026 (91 FR 48588 through 48654), 
make the following corrections:
    1. On page 48589, top of the page, TABLE 1: ESTIMATED COST AND 
BENEFITS is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.000

    2. On page 48594, middle of the page, TABLE 3: FY2027 UNADJUSTED 
FEDERAL RATE PER DIEM--URBAN is corrected to read:

[[Page 61784]]

[GRAPHIC] [TIFF OMITTED] TR30SE26.001

    3. On page 48594, middle of the page, TABLE 4: FY2027 UNADJUSTED 
FEDERAL RATE PER DIEM--RURAL is corrected to read:
[GRAPHIC] [TIFF OMITTED] TR30SE26.002

    4. On page 48596, top of page, TABLE 5: PDPM CASE-MIX ADJUSTED 
FEDERAL RATES AND ASSOCIATED INDEXES--URBAN is corrected to read:
[GRAPHIC] [TIFF OMITTED] TR30SE26.003


[[Page 61785]]


    5. On page 48597, top of the page, TABLE 6: PDPM CASE-MIX ADJUSTED 
FEDERAL RATES AND ASSOCIATED INDEXES--RURAL is corrected to read:
[GRAPHIC] [TIFF OMITTED] TR30SE26.004

    6. On page 48599, third column (below Table 7), first partial 
paragraph, line 8, the figure ``0.9989'' is corrected to read 
``0.9988''.
    7. On page 48601,
    a. Third column, first partial paragraph, line 2, the figure 
``$23,413.26'' is corrected to read ``$23,412.69''.
    b. Top of the page, TABLE 8: PDPM CASE-MIX ADJUSTED RATE 
COMPUTATION EXAMPLE is corrected to read:
[GRAPHIC] [TIFF OMITTED] TR30SE26.005


[[Page 61786]]


[GRAPHIC] [TIFF OMITTED] TR30SE26.006

    8. On page 48601, middle of the page ``TABLE 9: WAGE INDEX ADJUSTED 
RATE COMPUTATION EXAMPLE'' is corrected to read:
    9. On page 48602, top of the page, TABLE 10: ADJUSTED RATE 
COMPUTATION EXAMPLE is corrected to read:
[GRAPHIC] [TIFF OMITTED] TR30SE26.006


[[Page 61787]]


[GRAPHIC] [TIFF OMITTED] TR30SE26.007

    10. On page 48640,
    a. Top of the page, TABLE 18: U.S. BUREAU OF LABOR AND STATISTICS' 
MAY 2024 NATIONAL OCCUPATIONAL EMPLOYMENT AND WAGE ESTIMATES is 
corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.008


[[Page 61788]]


    b. Third column, second full paragraph,
    (1) Line 8 the figure ``$43.82'' is corrected to read ``$42.92''.
    (2) Line 10 the figure ``$525.84'' is corrected to read 
``$515.04''.
    (3) Line 10 the figure ``$43.82'' is corrected to read ``$42.92''.
    (4) Line 11 the figure ``$7,831,860.96'' is corrected to 
``$7,671,005.76''.
    (5). Line 12 the figure ``$525.84'' is corrected to ``$515.04''.
    c. Bottom of page, the table titled ``TABLE 19: ESTIMATED BURDEN 
REDUCTION ASSOCIATED WITH REMOVAL OF THE HCP COVID-19 VACCINE MEASURE 
BEGINNING WITH THE FY 2028 SNF QRP'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.009

    11. On page 48641,
    a. Second column, first partial paragraph,
    (1) Line 11, the figure ``$78.16'' is corrected to read'' $74.97''.
    (2) Line 13, the figure ``$61.68'' is corrected to read ``$59.94''.
    (3) Line 14,
    (a) The figure ``$94.64'' is corrected to read ``$90.00''.
    (b) The figure ``$78.16'' is corrected to read ``$74.97''.
    b. Third column, first full paragraph,
    (1) Line 6, the figure ``$78.16'' is corrected to read ``$74.97.''
    (2) Line 9, the figure ``$580,416'' is corrected to read 
``$556,727.22''.
    (3) Line 10, the figure ``$78.16'' is corrected to read ``$74.97''.
    (4) Line 14,
    (a) The figure ``$38.97'' is corrected to read ``$37.38''.
    (b) The figure ``$580,416'' is corrected to read ``$556,727.22''.
    c. Middle of the page, the table titled ``TABLE 20: ESTIMATED 
BURDEN ASSOCIATED WITH OMB CONTROL NUMBER (CMS-10387) RELATED TO THE 
SNF QRP BEGINNING WITH THE FY 2028 SNF QRP'' is corrected as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.010

    d. Third column, third partial paragraph (under table 20), line 2,
    (1) The figure ``$8,412,277.12'' is corrected to read 
``$8,227,732.98''.
    (2) The figure ``$564.81'' is corrected to read ``$552.42''.
    e. Bottom of page, the table titled ``TABLE 21: ESTIMATED BURDEN 
ASSOCIATED WITH SNF QRP BEGINNING WITH THE FY 2028 SNF QRP'' is 
corrected as follows:

[[Page 61789]]

[GRAPHIC] [TIFF OMITTED] TR30SE26.011

    f. Bottom of page, first column, footnoted paragraph (footnote 46), 
the link ``<a href="https://www.bls.gov/oes/current/oes_stru.htm">https://www.bls.gov/oes/current/oes_stru.htm</a>'' is corrected 
to read ``<a href="https://www.bls.gov/oes/special-requests/oesm24nat.zip">https://www.bls.gov/oes/special-requests/oesm24nat.zip</a>.''
    12. On page 48642,
    a. Second column, second full paragraph,
    (1) Line 15, the figure ``$78.16'' is corrected to read ``$74.97''.
    (2) Line 19, the figure ``$61.68'' is corrected to read ``$59.94''.
    (3) Line 20,
    (a) The figure ``$94.64'' is corrected to read ``$90.00''.
    (b) The figure ``$78.16'' is corrected to read ``$74.97''.
    b. Third column, first full paragraph,
    (1) Line 15, the figure ``$1,238,134.12'' is corrected to read 
``$1,187,601.27''.
    (2) Line 16,
    (a) The figure ``$78.16'' is corrected to read ``$74.97''.
    (b) The figure ``$83.13'' is corrected to read ``$79.74''.
    (3) Line 17, the figure ``$1,238,134.12'' is corrected to read 
``$1,187,601.27''
    c. Third column, second full paragraph,
    (1) Line 15, the figure ``$1,741,149.22'' is corrected to read 
``$1,670,086.45''.
    (2) Line 16,
    (a) The figure ``$78.16'' is corrected to read ``$74.97''.
    (b) The figure ``$116.90'' is corrected to read ``$112.13''.
    (3) Line 17, the figure ``$1,741,149.22'' is corrected to read 
``$1,670,086.45''.
    d. Third column, third full paragraph,
    (1) Line 13, the figure ``$2,979,283.34'' is corrected to read 
``$2,857,687.72''.
    (2) Line 14, the figure ``$1,238,134.12'' is corrected to read 
``$1,187,601.27''.
    (3) Line 15,
    (a) The figure ``$1,741,149.22'' is corrected to read 
``$1,670,086.45''.
    (b) The figure ``$200.03'' is corrected to read ``$191.87''.
    (4) Line 16, the figure ``$83.13'' is corrected to read ``$79.74''.
    (5) Line 17, the figure ``$116.90'' is corrected to read 
``$112.13''.
    13. On page 48643,
    a. Top of the page, the table titled ``TABLE 22: ESTIMATED BURDEN 
ASSOCIATED WITH OMB CONTROL NUMBER 0938-1140 (CMS-10387) RELATED TO THE 
SNF QRP BEGINNING WITH THE FY 2031 SNF QRP'' is corrected to read as 
follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.012

    b. Third column, first partial paragraph,
    (1) Line 17, the figure ``$88.28'' is corrected to read ``$86.68''.
    (2) Line 18, the figure ``$61.68'' is corrected to read ``$59.94''.
    (3) Line 19,
    (a) The figure ``$94.46'' is corrected to read ``$94.56''.
    (b) The figure ``$98.46'' is corrected to read ``$97.14''.
    (4) Line 20, the figure ``$94.64'' is corrected to read ``$90.00''.
    (5) Line 21,
    (a) The figure ``$92.16'' is corrected to read ``$91.74''.
    (b) The figure ``$88.28'' is corrected to read ``$86.68''.
    c. Third column, second full paragraph,
    (1) Line 3, the figure ``$85,066,753.66'' is corrected to read 
``$83,524,991.02''.
    (2) Line 4, the figure ``$88.28'' is corrected to read ``$86.68''
    (3) Line 6,
    (a) The figure ``$5,711.48'' is corrected to read ``$5,607.96''.
    (b) The figure ``$85,066,753.66'' is corrected to read 
``$83,524,991.02''.
    14. On page 48644,
    a. Top of the page, the table titled ``TABLE 23: ESTIMATED BURDEN 
ASSOCIATED WITH SUBMISSION OF MDS DATA ON ALL RESIDENTS ADMITTED FOR 
COVERED SKILLED CARE BEGINNING WITH THE FY 2031 SNF QRP'' is corrected 
to read as follows:

[[Page 61790]]

[GRAPHIC] [TIFF OMITTED] TR30SE26.013

    b. Third column, first partial paragraph under table 23,
    (1) Line 2, the figure ``$88,046,037.00'' is corrected to read 
``$86,382,678.74''.
    (2) Line 3, the figure ``$5,911.51'' is corrected to read 
``$5,799.83''.
    c. Middle of the page, the table titled ``TABLE 24: ESTIMATED 
BURDEN ASSOCIATED WITH SNF QRP PROPOSALS BEGINNING WITH THE FY 2031 SNF 
QRP'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.014

    15. Page 48646,
    a. Second column, first partial paragraph:
    (1) Line 4, the figure ``$525.84'' is corrected to read 
``$515.04''.
    (2) Line 7, the figure ``$7,831,860.96'' is corrected to read 
``$7,671,005.76''.
    (3) Line 8, the figure ``$525.84'' is corrected to read 
``$515.04''.
    b. Second column, first full paragraph,
    (1) Line 7, the figure ``$38.97'' is corrected to read ``$37.38''.
    (2) Line 9, the figure ``$580,416.16'' is corrected to read 
``$556,727.22''.
    (3) Line 10, the figure ``$78.16'' is corrected to read ``$74.97''.
    16. Page 48647,
    a. First column, first full paragraph after the heading ``(1) 
Impacts for Submission of Three New MDS Items Beginning With the FY 
2031 SNF QRP'',
    (1) Line 5, ``$1,238,134.12'' is corrected to read 
``$1,187,601.27''.
    (2) Line 6, ``$78.16'' is corrected to read ``$74.97''.
    b. Second column, first partial paragraph,
    (1) Line 4, ``$83.13'' is corrected to read ``$79.74''.
    (2) Line 9, ``$1,741,149.22'' is corrected to read 
``$1,670,086.45''.
    (3) Line 10, ``$78.16'' is corrected to read ``$74.97''.
    (4) Line 13, ``$116.90'' is corrected to read ``$112.13''.
    c. Second column, first full paragraph, line 6,
    (1) The figure ``$2,979,283.34'' is corrected to read 
``$2,857,687.72''.
    (2) The figure ``$200.03'' is corrected to read ``$191.87''.
    d. Third column, first partial paragraph,
    (1) Line 5, ``$85,066,753.66'' is corrected to read 
``$83,524,991.02''.
    (2) Line 6, ``$88.28'' is corrected to read ``$86.68''.
    (3) Line 9, ``$5,711.48'' is corrected to read ``$5,607.96''.
    e. Middle of the page, the table titled ``TABLE 26: ESTIMATED 
IMPACTS FOR THE FY 2028 SNF QRP'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.015


[[Page 61791]]


    f. Bottom of the page, the table titled ``TABLE 27: ESTIMATED 
IMPACTS FOR THE FY 2031 SNF QRP'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.016

    17. Page 48652, bottom of the page,
    a. The table titled ``TABLE 32: ACCOUNTING STATEMENT: 
CLASSIFICATION OF ESTIMATED SAVINGS FOR THE CHANGES TO THE FY 2028 SNF 
QRP'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.017

    b. The table titled ``TABLE 33: ACCOUNTING STATEMENT: 
CLASSIFICATION OF ESTIMATED EXPENDITURES FOR THE CHANGES TO THE FY 2031 
SNF QRP'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR30SE26.018


Liesl I. Fowler,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2026-19959 Filed 9-29-26; 8:45 am]
BILLING CODE 4169-69-P


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