This communication pertains to the Fiscal Year (FY) 2026 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Total Nursing Hours per Resident Day Staffing (Total Nurse Staffing) measure which the Centers for Medicare & Medicaid Services (CMS) published in the FY 2024 SNF Prospective Payment System (PPS) Final Rule on August 7, 2023. The Total Nurse Staffing measure is one of the four measures included in the SNF VBP Program for the FY 2026 Program year. This communication does not affect the current FY 2025 SNF VBP Program scoring and incentive payments nor does it affect prior FYs. SNFs do not need to do anything at this time, or in the future. The performance standards for each measure adopted by the SNF VBP Program consist of the achievement threshold and the benchmark. The achievement threshold is the 25th percentile of all SNFs’ performance on a measure during the Program year’s applicable baseline period, and the benchmark is the mean of the top decile of all SNFs’ performance on a measure during the Program year’s applicable baseline period. For the FY 2026 SNF VBP Program year, the baseline period is FY 2022 and the performance period is FY 2024 for the Total Nurse Staffing measure. The performance standards are used together with each SNF’s performance on a measure during the baseline period and the performance period to calculate a measure score for each measure, for each SNF.
CMS identified a technical update for the Total Nurse Staffing measure which impacts the calculation of the achievement threshold and benchmark for the FY 2026 SNF VBP Program year. The Total Nurse Staffing measure’s case-mix adjustment methodology uses items from the Nursing Home Minimum Data Set (MDS), including Section G data elements. CMS updated the MDS 3.0 to remove Section G data elements starting at the beginning of FY 2024 (October 1, 2023). As a result of this update, the case-mix adjustment methodology needs to be updated for measure calculations using data from FY 2024 and forward. To confirm the performance standards calculated using FY 2022 data are as comparable as possible to the performance period measure results to be calculated using data from FY 2024, CMS is updating the performance standards. The technical measure specifications are described in more detail in the appendix to the Five Star Quality Rating System Technical Users Guide.
The table below displays the original performance standards published in the FY 2024 SNF PPS final rule and the updated performance standards. The updated performance standards will be used in upcoming FY 2026 SNF VBP Program scoring and payment calculations. As mentioned above, this update does not affect SNF VBP Program scoring and incentive payments for the current FY 2025 SNF VBP Program, nor did it affect scoring and incentive payments in prior FYs. SNFs do not need to do anything at this time, and this process will not require any future action from providers.
| Original Performance Standards Published in FY 2024 Final Rule | Updated Performance Standards | |
| Benchmark | 5.70680 | 5.78096 |
| Achievement Threshold | 3.18523 | 3.21986 |
Please contact the SNF VBP Program Help Desk at [email protected] with any questions.