Reimbursement changes, regulatory updates, and clinical intelligence across skilled nursing, home health, hospice, and assisted living — delivered before your morning huddle.
Compare your patient across all four post-acute settings. Enter key clinical indicators to see which setting produces the best reimbursement alignment for each patient's needs.
Comparison based on CMS FY2026 payment rates and published clinical appropriateness criteria. Actual reimbursement varies by patient case mix, geographic wage index, and payer contracts. This is a clinical and financial planning tool only — not a substitution for individualized clinical judgment or coverage determination.
The only briefing that covers SNF, home health, hospice, and ALF in one place. What changed, what it means, and what to do about it.
CMS's FY2026 SNF PPS final rule distributes the +3.0% market basket update unevenly across case mix groups. NTA-heavy facilities and those with strong cognitive impairment capture above-average rate increases.
LUPA rates continue to be the most-audited billing pattern in home health under PDGM. Agencies with LUPA rates above 15% face elevated review activity. The threshold varies significantly by HIPPS code.
General Inpatient hospice billing remains the primary OIG target in the hospice space. Documentation of unmanageable symptom burden must be explicit. "Pain not controlled" alone is insufficient.
Medicaid HCBS waiver expansions continue to reshape the ALF competitive landscape. Facilities that document person-centered planning and resident rights protections are better positioned for Medicaid referrals.
Hospital readmission penalties affect referring hospitals across all PAC settings. SNFs, HHAs, and hospices that can demonstrate lower readmission rates have a measurable competitive advantage in referral relationships.
Phase 2 of CMS minimum staffing requirements is in effect. The 3.48 total HPRD and 0.55 RN HPRD minimums now carry citation authority. Facilities below threshold face survey deficiency findings.
For case managers and social workers. Answer 4 questions to get a recommended care setting, length of stay estimate, and red flags.
Quick reference for all post-acute care settings. 2026 final rule updates applied.
| PDPM Component | Category | 2025 Rate | 2026 Rate (+4.2%) |
|---|---|---|---|
| Physical Therapy (PT) | All patients | $200/day | $209/day |
| Occupational Therapy (OT) | All patients | $149/day | $155/day |
| Speech-Language Pathology (SLP) | All patients | $130/day | $135/day |
| Non-Therapy Ancillaries (NTA) | Tier 0 (0 comorbidities) | $72/day | $75/day |
| Non-Therapy Ancillaries (NTA) | Tier 1 (1–2 comorbidities) | $101/day | $105/day |
| Non-Therapy Ancillaries (NTA) | Tier 2 (3–5 comorbidities) | $130/day | $135/day |
| Non-Therapy Ancillaries (NTA) | Tier 3 (6+ comorbidities) | $173/day | $180/day |
| Nursing Component | Category 1 (non-case mix) | $94/day | $98/day |
| Nursing Component | Category 3 (extensive svcs) | $130/day | $135/day |
| Nursing Component | Category 5 (special care high) | $173/day | $180/day |
| Non-Therapy Ancillaries | Non-case mix component | $40/day | $42/day |
| Clinical Grouping | Timing | 2026 Base Rate / 30-Day Episode |
|---|---|---|
| Musculoskeletal Rehabilitation | Early (days 1–30) | $2,890 |
| Musculoskeletal Rehabilitation | Late (days 31–60+) | $1,890 |
| Neuro Rehabilitation | Early | $3,210 |
| Neuro Rehabilitation | Late | $2,100 |
| Wounds: Post-Op | Early | $2,620 |
| Wounds: Post-Op | Late | $1,710 |
| Complex Medical | Early | $3,580 |
| Complex Medical | Late | $2,340 |
| Medication Management/Teaching | Early | $1,890 |
| Cardiac/Circulatory | Early | $2,780 |
| Respiratory | Early | $2,540 |
| Condition Category | CMG Range | 2026 Avg Rate / Stay | Avg LOS |
|---|---|---|---|
| Stroke | 0100–0199 | $22,400 | 14–16 days |
| TBI (Traumatic Brain Injury) | 0200–0299 | $26,800 | 16–20 days |
| Hip Fracture | 0800–0899 | $18,900 | 12–14 days |
| Total Hip/Knee Replacement | 0801–0802 | $17,200 | 10–12 days |
| Major Multiple Trauma | 2500–2599 | $31,600 | 18–24 days |
| Cardiac Disorders | 1200–1299 | $19,800 | 12–14 days |
| Pulmonary Disorders | 1500–1599 | $20,100 | 12–15 days |
| Neurological Disorders | 0500–0599 | $23,400 | 14–18 days |
| MS-LTC-DRG Category | Condition | 2026 Avg Rate / Discharge | Avg LOS |
|---|---|---|---|
| Respiratory — Ventilator | Prolonged mechanical ventilation | $68,400 | 26–34 days |
| Septicemia | Severe sepsis with organ failure | $42,800 | 20–28 days |
| Renal Failure | Dialysis-dependent, complex | $38,600 | 18–24 days |
| Complex Wounds | Infected wounds, dehiscence | $36,200 | 18–22 days |
| Cardiac Procedures (Complex) | CABG complications, valve repair | $51,200 | 22–28 days |
| TBI with Vent Support | Acute brain injury complex care | $58,800 | 24–32 days |
One briefing covering all four post-acute settings. Administrators, clinical directors, and PAC executives read it before the morning huddle.