September 8, 2025
The Centers for Medicare & Medicaid Services (CMS) has released new details about the Transforming Episode Accountability Model (TEAM), which will run from January 1, 2026, through December 31, 2030. One key feature of this initiative is a waiver of the traditional Skilled Nursing Facility (SNF) Three-Day Rule, which generally requires patients to have a qualifying three-day inpatient hospital stay before Medicare will cover their SNF care.
Under TEAM, acute care hospitals participating in the model will be able to discharge patients directly to a qualified SNF or swing bed provider, including critical access hospitals, without the usual three-day inpatient requirement. This change is intended to provide more flexibility in post-acute care transitions and improve patient outcomes by allowing the right level of care at the right time.
To qualify, patients must meet TEAM eligibility criteria and have either a qualifying outpatient procedure or a hospital inpatient stay prior to their admission to the SNF. Additionally, the patient’s SNF admission must occur within 30 days of discharge from the hospital or outpatient department.
CMS will reimburse SNF services under the waiver when certain payment criteria are met. Specifically, facilities must submit claims using the required TEAM demonstration code A9 to receive payment.
This new waiver represents an important shift in how Medicare supports post-acute care, offering hospitals and SNFs more flexibility in coordinating care while reducing unnecessary inpatient stays. Providers should begin preparing now to understand the participation requirements and ensure compliance with payment and coding rules once TEAM takes effect in 2026.
For more information, read CMS’ MLN Matters article.