October 1st Medicare Changes Are Here: Is Your SNF Ready?

October 1st is always a big date on the Skilled Nursing Facility calendar, and this year is no different. With new Medicare rules officially in effect, facilities need to confirm they’ve made the necessary updates to stay compliant and avoid costly mistakes. The good news? The changes are manageable — but only if you’ve taken the time to prepare your teams and workflows.

Let’s walk through the key updates that went live October 1, 2025, and what you should be checking now to make sure your SNF is on track.

Payment and PDPM Updates

CMS finalized a 3.2% net increase in SNF PPS rates for FY 2026. That’s welcome news, but it comes with adjustments that require attention. In particular, there are 34 ICD-10 code mapping changes under PDPM.

What to do now:

• Make sure your coding team has reviewed the new mapping files.
• Confirm your EHR and billing system reflect the new codes.
• Double-check that diagnoses are still classifying correctly under PDPM, so you’re not leaving reimbursement on the table.

MDS Changes You Can’t Ignore

The new MDS v1.20.1v3 went live October 1. Here’s what’s different:

• Section R (SDOH items) is gone — you no longer need to collect living situation, food, utility, and transportation data.
• Therapy reporting has been streamlined. O0400 therapy minute reporting has been replaced by O0390 checkboxes for services provided 15+ minutes/day.
• Terminology tweaks: A0800 “Gender” is now A0810 “Sex,” and transportation questions were simplified.

What to do now:

• Train staff on the new MDS forms so they aren’t submitting outdated data.
• Review therapy documentation workflows to make sure O0390 is captured correctly.
• Update policies to reflect what’s no longer required.

Quality Reporting and VBP

CMS also finalized changes that directly affect reimbursement through the Quality Reporting Program (QRP) and Value-Based Purchasing (VBP):

• QRP: If you miss required reporting, you could lose 2% of your APU. With Section R gone, make sure your staff aren’t wasting time collecting unneeded data.
• VBP: The Health Equity Adjustment has been removed — all facilities now compete on the same performance scale. A new reconsideration process is also available if you need to appeal performance scores.

What to do now:

• Audit your QRP submissions to ensure you’re meeting requirements under the new rules.
• Review your VBP scores and set up a process for filing reconsideration requests if needed.

The Bottom Line

The October 1st updates are now live, and CMS expects compliance immediately. While the rate increase is a welcome boost, it won’t mean much if you miss out on reimbursement because of coding errors, outdated MDS practices, or incomplete quality reporting.

If your SNF hasn’t already:

• Audit coding workflows against the new PDPM mappings,
• Train your MDS and clinical staff on the v1.20.1v3 changes, and
• Review QRP/VBP compliance processes.

These updates may feel like one more item on a long compliance checklist, but they directly impact your revenue and survey readiness. Taking action now ensures your facility captures every dollar it’s entitled to — and avoids penalties down the road.

Is your SNF prepared? If not, today’s the day to get your house in order.