[UPDATED] CMS Proposes 4.1% Increase to Medicare Payments, While Expanding Monetary Penalties

The Centers for Medicare & Medicaid Services (CMS) issued its proposed rule that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System for fiscal year 2025. CMS also proposed to expand the penalties that can be imposed through regulatory revision to allow for more per instance […]

‘Borderline Useless’ CMS Data Needs an Overhaul, Starting with the Addition of Medicare Advantage to Cost Reports

Conspicuously absent data on Medicare Advantage (MA), along with stagnated data collection overall by government agencies, should give nursing home operators cause for concern especially as this trend has influenced company advocacy and negotiating power when it comes to insurance plans. Having this data and understanding how it’s calculated can help operators “speak the same […]

Aldersbridge CEO: Tone Deaf Policy, MA Giants Have Backed Nursing Homes into a Corner

As inadequate funding squeezes nursing homes dry, with Medicare Advantage reimbursing lower than traditional Medicare, and Medicaid funding decades behind on meeting cost of care, facilities are shifting operations to optimize reimbursement. But even that may not be enough. Richard Gamache, CEO of Aldersbridge Communities in Rhode Island, has had to make such operating decisions […]

‘Money Out of Our Pockets’: $274.9M in Nursing Home Revenue Lost For Every Percentage MA Plans Grow

As Medicare Advantage continues to grow in the skilled nursing space, beneficiaries utilizing traditional Fee-For-Service Medicare have declined, and in turn reimbursement has dropped at an alarming rate. For every two beneficiaries that opted for MA, one FFS individual left the program in 2023, the first year the number of FFS beneficiaries declined in every […]

Sabra’s Matros Says No ‘False Guardrails’ Around M&A Pipeline, Potential Skilled Nursing Deals

The year ahead for Sabra Health Care REIT (Nasdaq: SBRA) presents a “terrific” opportunity for improved margins and potential dealmaking, with eyes on multiple asset classes, according to Sabra CEO Rick Matros. While the California-based real estate investment trust (REIT) has focused in the past couple years on diversifying its portfolio – namely adding behavioral […]

HDG: How Hospitals, Nursing Homes Can Minimize ‘Headwinds’ From Policy Oversight of Medicare Advantage Plans

As nursing homes and hospitals confront lingering concerns with inpatient backlogs, lengths of hospital stay, and tighter operating margins, the growth of Medicare Advantage plans – and now greater scrutiny over their prior authorization protocols by the federal government – will only serve to squeeze profits margins. “So those are additional headwinds that will benefit […]

‘Elephant in the Room’: Medicare Advantage a Huge Factor in CCRC Decision Making Around Nursing Home Services

Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) to provide such labor intensive post-acute care. CCRCs have to ask themselves some hard questions when it comes to what services they can reasonably offer, and if it’s worth it to keep open […]

Big Players in Medicare Advantage, Cigna and HCSC, Involved in Planned $3.3B Deal 

As Medicare Advantage becomes an increasingly important – and controversial – payer for skilled nursing services, operators should note a major shift has occurred in the insurance landscape. Cigna Group (NYSE: CI) agreed Wednesday to sell its Medicare businesses and CareAllies to Health Care Service Corporation (HCSC). HCSC said it intends to acquire the Cigna […]

Inside the CMS Policies That Could Improve Care, Payments for Dual-Eligible Nursing Home Residents

Given that a vast majority of long-stay nursing home residents are dual eligible for Medicare and Medicaid, residents and facilities alike can reap financial benefits while improving quality of care and reducing administrative burdens if federal and state policies better enabled a value-based care model that integrated the experiences of dual eligibles. This is the […]

OIG Plans To Audit Nursing Home Survey Practices This Year – With Results Expected in 2025

The Office of the Inspector General (OIG) will be auditing nursing home survey practices this year with results expected in 2025, following concerns that third-party contractors may not have sufficient oversight in the space. OIG suggested closer scrutiny of the Centers for Medicare & Medicaid Services (CMS) regulatory practices when it came to surveys, given […]

Why the Proposed Medicare Advantage Plan and Part D Rule Is Favorable for the Nursing Home Space

The federal government’s Medicare Advantage and Part D proposed rule offers nursing home operators several favorable updates, including those related to the appeals process for terminating SNF services as well as alleviating burdens posed by choice and multiple plans for dual eligible residents. The Centers for Medicare & Medicaid Services (CMS) has been working on […]

Nursing Home Operators Feel There’s a Lot to Learn From Hospice Surveys Despite Regulatory Differences

Many nursing home operators that also have hospice operations can’t help but notice that the survey process on the hospice end is generally a more positive experience than in the nursing home world. And some say the collaborative nature – between facilities and the federal government – of hospice surveys can and should be replicated […]

CMS Focuses on Resident Mood Interviews in Newly-Issued Nursing Home MDS Draft

The Centers for Medicare & Medicaid Services (CMS) on Friday issued its draft Minimum Data Set (MDS) — earlier than the federal agency’s typical timeline and with less sweeping changes compared to past years. Changes, effective Oct. 1, include an update to the list of state RAI coordinators, MDS automation coordinators, CMS locations and contacts, […]

As a ‘Better Advisor’ to Congress, MedPAC Mulls CMS Staffing Mandate Effects But Proposes 3% Medicare Cut

The majority of MedPAC board members voted Thursday to recommend reducing Medicare-based payment rates for skilled nursing spending by 3% for 2025, despite voicing concerns about the federal minimum staffing proposed rule. MedPAC, which stands for the Medicare Payment Advisory Commission, is made up of health care professionals who make recommendations to Congress in terms […]

KFF: Nursing Home Deficiencies Jumped Almost 10% Since 2015 and Staffing Levels Are To Blame

Deficiencies in nursing homes, both on average and those deemed more serious, have increased over time – partly as a result of decreasing staffing levels. Between 2015 and 2023, facilities with serious deficiencies, or violations of federal regulations, increased from 17% to 26%, according to a data note published on Friday by KFF. The average […]

Nursing Home Associations: HHS Needs To Do Its Part to Boost Vaccine Uptake as Latest CDC Data Shows Lags

The Department of Health and Human Services (HHS) and its Secretary, Xavier Becerra, need to “do its part” to increase Covid vaccination rates among nursing home residents, starting with easing logistical issues that continue to be barriers to uptake. That’s according to LeadingAge President and CEO Katie Smith Sloan, who also cited the benefits of […]

Comprehensive Healthcare Legal Saga Culminates in Acquittal of Individuals, Guilty Verdict for Corporate Defendants

Pennsylvania operator Comprehensive Healthcare Management Services was found guilty in a sprawling health care fraud case, following a five-week federal trial in Pennsylvania, involving two of its facilities. Brighton Rehabilitation and Wellness Center and Lebanon Rehabilitation and Wellness Center were found guilty of making false statements in connection with the payment of health care benefits […]

‘Tougher Every Day’: Nursing Home Operators, CCRCs Weigh in on Future of Skilled Nursing

Operating a skilled nursing facility today is considered a difficult business with regulations and reimbursement woes making the space “tougher every day.” As a result, some operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. This dire view of […]

Nursing Home and CCRC Spending Grew 5.6% to $191.3B in 2022 – After Dropping 7.8% in 2021

Nursing homes and continuing care retirement communities (CCRCs) made up $191.3 billion of national health expenditures in 2022, an increase from $181.1 billion in 2021, reaching levels close to the onset of the Covid-19 pandemic. Pre-pandemic, such expenditures sat between $162 billion and $174.1 billion between 2016 and 2019, according to a survey published by […]