Payment Boosts, Survey Shifts, and Ohio Policy Moves

Beyond the Fine Print — Week of Aug 1–8, 2025

National — CMS & CDC

• SNF PPS Final Rule (FY 2026) is out. Net +3.2% payment update (~$1.16B). Effective Oct 1, 2025. Includes PDPM code mapping updates and other policy tweaks. https://www.federalregister.gov/documents/2025/08/05/2025-16343/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities
• Survey policy cleanup. CMS ended Focused Infection Control surveys and updated related enforcement guidance on July 30; complaints still drive infection control investigations. https://www.cms.gov/files/document/qso-25-20-nh.pdf
• Care Compare changes live (July 30). Chain-level performance now posted; COVID-19 vaccination info removed from nursing home profile pages. https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-and-cms-locations/updates-nursing-home-care-compare#:~:text=Removing%20COVID%2D19%20Vaccination%20Measures,Linkedin%20link
• Infection control—new CDC toolkit for LTCFs. CDC released/updated Group A Strep outbreak resources this week: decision tools, transmission guidance, and antibiotic regimens. https://www.cdc.gov/group-a-strep/php/ltcf-toolkit/index.html
• Heads-up from MLN Connects (Aug 7). CMS issued corrected July ZIP code files for ambulance claims; MACs will reprocess—FYI for facilities that bill transport. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-august-7-2025#_Toc205285432

Ohio — Medicaid, Rules, Plans

• Prior auth enforcement started Aug 1 (FFS). ODM will deny claims without an approved PA under the updated FFS policy. Managed care rules unchanged; verify your workflows. https://medicaid.ohio.gov/resources-for-providers/billing/prior-authorization-requirements/prior-authorization-requirements
• Managed care updates. Check CareSource’s August policy updates page and UHC Community Plan of Ohio August bulletin (Ohio-specific policies; several effective Sept 1). CareSource Link: https://www.caresource.com/oh/providers/tools-resources/updates-announcements/medicaid/ UHC Link: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/rpub/community-plan-reimbursement-update-bulletin-june-2025.pdf
• Licensure rules site refreshed. OAC Chapter 3701-17 pages show updates posted this week (effective dates remain July 17, 2025, for most revised rules). https://codes.ohio.gov/ohio-administrative-code/chapter-3701-17
• ODH rulemaking watch. Hospice draft rules posted Aug 1. https://odh.ohio.gov/about-us/offices-bureaus-and-departments/ogc/draft-rules/draft-rule-3701-192

What to do this week (rapid ops)

• Budget & rates: Update FY26 pro formas for the +3.2% SNF PPS and brief finance/QAPI by Aug 15. https://www.federalregister.gov/documents/2025/08/04/2025-14679/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities
• Survey readiness: Remove references to FIC surveys from your survey prep binder; reinforce complaint-driven infection control triage. https://www.cms.gov/files/document/qso-25-20-nh.pdf
• Public-facing data: Review your chain’s Care Compare footprint; prepare talking points for families/referrals on star trends. https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-and-cms-locations/updates-nursing-home-care-compare#:~:text=Removing%20COVID%2D19%20Vaccination%20Measures,Linkedin%20link
• Infection prevention: Add the CDC GAS toolkit to your IC policy, in-service DON/ICPs, and create a mini-drill for admission screening + lab/antibiotic pathways. https://www.cdc.gov/groupastrep/hcp/ltcf/index.html
• Revenue integrity (Ohio): Audit PA workflows for FFS claims since Aug 1; spot-check one week of discharges for PA evidence. https://medicaid.ohio.gov/resources-for-providers/billing/prior-authorization-requirements/prior-authorization-requirements
• MCO scanning (Ohio): Route the CareSource and UHC Community Plan August updates to billing/UM; adjust any LOC/auth templates effective Sept 1. CareSource Link: https://www.caresource.com/oh/providers/tools-resources/updates-announcements/medicaid/ UHC Link: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/rpub/community-plan-reimbursement-update-bulletin-june-2025.pdf