On April 10, 2023, CMS published in the Federal Register (88 FR 21316) a proposed rule updating for fiscal year (FY) 2024 the Medicare skilled nursing facility (SNF) payment rates, SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing Program (VBP). The proposed rule would update the federal per diem rates under the SNF Prospective Payment System; the ICD-10 code mappings for patient classification; and the SNF QRP and SNF VBP Programs. CMS also proposes revisions in the procedures for facilities facing civil monetary penalties to actively waive their right to a hearing in writing to receive a penalty reduction. For the SNF QRP, CMS proposes adopting three new measures, removing three measures, and modification of one measure. CMS also proposes public reporting of four measures. Substantive proposals are made for the SNF VBP Program that progressively change the program’s measure set and make policy revisions to implement the larger measure set. CMS proposes a Health Equity Adjustment that would reward SNFs that perform well and whose resident population during the applicable performance period includes at least 20% of residents with dual eligibility status; this adjustment would begin with the FY 2027 program year and FY 2025 performance year. In addition, CMS proposes to increase the payback percentage policy under the SNF VBP program. Comments on the proposed rule are due by June 5, 2023.