MedPAC Convenes September 2026 Public Meeting Addressing Post-Acute and Skilled Nursing Payments

MedPAC Zeroes In on Medicare Advantage Post-Acute Alignment

A key agenda item: alignment between Medicare Advantage payment mechanisms and clinical care delivery in post-acute settings. For SNF operators navigating a patchwork of reimbursement thresholds and acuity-driven case-mix adjustments, the commission's focus signals a potentially significant recalibration of how Medicare dollars flow to skilled nursing. The proceedings dropped the same week CMS rolled out its new nationwide Risk-Based Survey system—raising the regulatory pressure on operators from multiple angles simultaneously.

CMS Launches Risk-Based Survey, Tightens Recertification Lens

Effective September 8, 2026, the Centers for Medicare & Medicaid Services officially activated its Risk-Based Survey system, streamlining recertification inspections for roughly 12 percent of high-performing nursing homes. The calculus is strict: facilities must hold five-star overall ratings and carry clean harm deficiency citation records to qualify. Those meeting the threshold will also see a new Care Compare icon on their profiles beginning September 30—a visible market differentiator in an industry where referral networks and managed-care contracts increasingly hinge on public quality data.

The flip side is operational parity. The remaining 88 percent of facilities stay locked into standard recertification cycles, with no inspection relief and no new visual credential. For multi-site operators managing mixed portfolios, the split creates a two-tier compliance workload: streamlined surveys for top performers, unchanged audit exposure for the rest. Deficiency citations—particularly those tagged as actual harm—now carry outsized leverage, not just for penalty exposure but for survey pathway eligibility.

Resident Council Pilot Yields Measurable Quality Gains

An 18-month pilot across 31 Connecticut nursing homes, led by the Moving Forward Coalition and supported by The John A. Hartford Foundation, demonstrated that formalized, empowered resident councils directly improve quality-of-life metrics and care outcomes. The coalition plans to translate the findings into a national framework aimed at strengthening resident participation in facility-level decision-making—a move that could reshape governance expectations at the state survey level.

For operators, the pilot's significance is structural: resident councils are already a CMS Conditions of Participation requirement, but enforcement and rigor vary widely by state. A national framework with measurable quality benchmarks could transform what's currently a compliance checkbox into a genuine performance metric—particularly if surveyors begin weighting resident council activity in deficiency assessments or Quality Measure calculations.

The Bottom Line

MedPAC's September review, the CMS Risk-Based Survey launch, and the resident council quality pilot converge on a single operational reality: the regulatory environment is rewarding demonstrable outcomes and tightening scrutiny where performance gaps persist. SNF operators should audit their current five-star ratings, harm citation histories, and resident council structures before the Care Compare icon rollout on September 30—and before the MedPAC review generates concrete payment reform proposals. Facilities sitting on the wrong side of these thresholds face compounding compliance risk and potential reimbursement exposure.