Scoring Methodology & Payment Adjustment

Scoring Methodology & Payment Adjustment

For the FY 2026 SNF VBP Program year, the SNF VBP Program will assess performance on four quality measures during a baseline period and performance period: the SNF 30-Day All-Cause Readmission Measure (SNFRM), the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization (SNF HAI) measure, the Total Nursing Staff Turnover (Nursing Staff Turnover) measure, and the Total Nurse Staffing Hours per Resident Day (Total Nurse Staffing) measure. The table below summarizes the baseline and performance periods for each measure for the FY 2026 Program year. 

FY = Fiscal Year.

CMS calculates achievement, improvement, and measure scores for each measure in the SNF VBP Program using baseline period measure results, performance period measure results, and two performance standards (the achievement threshold and the benchmark; the table below summarizes the two performance standards for each measure for the FY 2026 Program year).

1. Improvement scores compare a SNF’s measure result in the performance period to that SNF’s own past performance during the baseline period. Improvement scores range from 0 to 9; higher scores are better.
2. Achievement scores compare a SNF’s measure result in the performance period to national SNF performance during the baseline period. Achievement scores range from 0 to 10; higher scores are better.
3. Measure scores compare a SNF’s improvement and achievement score for each measure; whichever score is higher becomes the measure score. Measure scores range from 0 to 10; higher scores are better.

CMS then normalizes (that is, rescales) each measure score and combines all the normalized measure scores into a single, overall performance score. Performance scores range from 0 to 100; higher scores are better. 

For more in-depth information on how achievement, improvement, measure, and performance scores are calculated, please see the FY 2023 SNF PPS final rule (pages 47588–47590) and the SNF VBP Program: FY 2026 Incentive Payment Multiplier Calculation Infographic (PDF).

Incentive Payment Calculation Methodology

Each SNF’s performance score is transformed into an incentive payment multiplier (IPM) using a logistic (or S-shaped) exchange function, which is applied to your SNF's adjusted federal per diem rate for services provided during the applicable SNF VBP Program year. When CMS makes payments for a SNF’s Medicare fee-for-service Part A claims, the adjusted federal per diem rate is multiplied by the SNF’s IPM. Please see the SNF VBP Program Exchange Function Methodology Report (PDF) for more information about why the logistic exchange function was selected and how SNF performance scores are used to derive incentive payments.

For more information on how IPMs are calculated, please see the SNF VBP Program: FY 2026 Incentive Payment Multiplier Calculation Infographic (PDF).

Case Minimum Policy and Scoring Policy for SNFs Without Sufficient Baseline Period Data

In the FY 2023 SNF PPS final rule (pages 47585–47587) and the FY 2024 SNF PPS final rule (pages 53301-53302), CMS finalized case minimum policies for each of the four quality measures in the FY 2026 SNF VBP Program year. In the FY 2026 Program year, SNFs must meet the applicable measure’s case minimum during the performance period to receive a measure score. If a SNF does not meet the case minimum for a particular measure during the performance period, that measure is not included in the calculation of a performance score or IPM. The table below summarizes the case minimum for each measure.

If a SNF does not meet the case minimum for a particular measure during the baseline period only, the SNF will only be scored on achievement; the SNF will not be scored on improvement, so the SNF’s achievement score will equal their measure score.

Next, in the FY 2024 SNF PPS final rule (page 53302), CMS finalized a measure minimum policy for the FY 2026 Program year. To receive a performance score and IPM for the FY 2026 Program year, SNFs must meet the case minimum during the performance period for at least two of the four quality measures. 

If a SNF does not meet the measure minimum policy, the SNF will be excluded from the SNF VBP Program for FY 2026. Payments to these SNFs will not be affected by the SNF VBP Program, and these SNFs will not receive a performance score or IPM for the FY 2026 Program year; instead, they will receive their adjusted federal per diem rate. 

Resources

• SNF VBP Program: FY 2026 Incentive Payment Multiplier Calculation Infographic (PDF)
• SNF VBP Program Exchange Function Methodology Report (PDF)