Measures

Quality Measures Adopted for the FY 2026 Program

For the FY 2026 Program year, the SNF VBP Program will award incentive payments to SNFs based on their performance on four quality measures:

1. The SNF 30-Day All-Cause Readmission Measure (SNFRM) (PDF). This measure evaluates the annual risk-standardized rate of unplanned, all-cause hospital readmissions.
2. The Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization (SNF HAI) measure (PDF). This measure evaluates the annual risk-standardized rate of healthcare-associated infections requiring hospitalization that are acquired during SNF care.
3. The Total Nursing Staff Turnover (Nursing Staff Turnover) measure (PDF). This measure evaluates the annual turnover rate among eligible SNF staff, including registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides.
4. The Total Nursing Hours per Resident Day (Total Nurse Staffing) measure (PDF). This measure evaluates the average case-mix adjusted total nursing staff hours (including RNs, LPNs, and nurse aides) per resident day.

CMS will assess SNFs’ performance on these measures during a baseline period and performance period. The table below summarizes the baseline and performance periods for each measure for the FY 2026 Program year.

FY = Fiscal Year.

Expansion of the SNF VBP Program

Beginning in the FY 2027 Program year, the SNF VBP Program will expand to assess performance on eight quality measures rather than four measures (for the FY 2026 Program year) or a single measure (for the FY 2019-FY 2025 Program years). 

In Section 111 of the Consolidated Appropriations Act, 2021, Congress amended Section 1888(h) of the Social Security Act to allow the HHS Secretary to apply up to nine additional measures to the SNF VBP Program. In the FY 2023 SNF PPS final rule (pages 47564–47580), CMS adopted three additional measures. In the FY 2024 SNF PPS final rule (pages 53276-53304), CMS adopted four additional measures, and finalized one measure replacement. 

The following table lists the measures currently adopted for the FY 2025 through FY 2028 Program years, as finalized through the federal rulemaking process.

Resources

• Original SNFRM Technical Report (PDF), 2023 Measure Updates and Specifications Report: Skilled Nursing Facility 30-Day All-Cause Readmission Measure (PDF) (PDF), and 2024 Measure Updates and Specifications Report: Skilled Nursing Facility 30-Day All-Cause Readmission Measure (PDF)
• SNFRM Reliability Testing Memo (PDF)
• Specifications for the Skilled Nursing Facility Healthcare-Associated Infections (SNF HAI) Requiring Hospitalization Measure (PDF)
• Specifications for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program: Total Nursing Hours per Resident Day Measure (PDF)
• Specifications for the Total Nursing Staff Turnover Measure (PDF)
• Specifications for the Discharge to Community—Post-Acute Care (DTC-PAC) Measure for SNFs (PDF)
• Specifications for the Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay) Measure (PDF)
• Specifications for the Discharge Function Score for SNFs Measure (PDF)
• Specifications for the Number of Hospitalizations per 1,000 Long Stay Resident Days Measure (PDF)
• Specifications for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program: SNF Within-Stay Potentially Preventable Readmission Measure (PDF)