CMS "TEAM" Model Offers Opportunities for Nursing Homes and Residents

(Oct. 14, 2025) Set to launch on Jan. 1, 2026, the Centers for Medicare and Medicaid Services' (CMS) new Transforming Episode Accountability Model (TEAM) offers the opportunity for waivers of the three-day hospital stay requirement for certain patients seeking admission to qualifying skilled nursing facilities (SNFs). TEAM is a new Medicare episode-based payment arrangement that will apply to all Medicare fee-for-service beneficiaries receiving care from a participating hospital in one of five surgical procedures.

All hospitals in specified geographic regions will be required to participate in the model, and other hospitals may opt in. Many NY hospitals are mandatory participants. A list of all hospitals mandated to participate is here.

Participating hospitals may seek a waiver of the three-day stay requirement for Medicare coverage of SNF care for their patients who receive a covered procedure. Only qualifying nursing homes, defined as those with a three-star or higher rating for at least seven of the last 12 months, are eligible for the waiver. Nursing homes that are able to partner effectively with hospitals in their regions on post-acute care for the covered procedures may also benefit from increased referrals.

The TEAM model will continue through Dec. 31, 2030. More information is available from LeadingAge National here, the Medicare Learning Network here, and the CMS TEAM model website here. As previously reported here, a LeadingAge National free-for-members-only webinar about TEAM is available through the Learning Hub here.

Contact: Karen Lipson, klipson@leadingageny.org