CMS has finalized a 2026 rule that removes 285 procedures from the inpatient-only list, allowing many surgeries historically performed in hospitals to shift to outpatient settings. While CMS emphasized that clinicians should continue admitting frail or medically complex older adults as inpatients when appropriate, the agency did not pair this change with any broad protection of skilled nursing coverage for individuals whose procedures occur on an outpatient basis. The agency’s overview is available in the 2026 OPPS/ASC fact sheet.
For nonprofit aging services providers, the implications are significant. Many of the affected procedures have long driven a substantial share of skilled nursing admissions; if completed on an outpatient basis, those same individuals would not meet Medicare’s three-day inpatient stay requirement for SNF coverage. This could lead to gaps in access for older adults who still need rehabilitative or transitional care and may shift hospital discharge patterns that members rely on to stabilize census. LeadingAge has cautioned that surgeons may not always recognize the post-acute consequences of selecting an outpatient setting, potentially leaving some older adults without needed support. Members may wish to monitor discharge planning trends closely and continue advocating for modernization of the three-day rule so that changing hospital practices do not limit appropriate access to skilled care.