Some Medicare Contractors Holding Up Claim Payments Amid the Shift to PDPM

Some of the private insurance companies that process Medicare claims on behalf of the federal government are holding up claims for skilled nursing facilities after the implementation of the Patient-Driven Payment Model (PDPM) in October. But it’s not clear how widespread that is, BKD director John Harned and senior managing consultant Sherri Robbins said on […]

Citing ‘Shady’ Behavior, CMS Proposes Stricter Rules, Time Limit on Medicaid Payment Supplements

Nursing home providers in multiple states have won key funding increases through the use of novel Medicaid supplement programs — but the federal government now wants to keep a tighter leash on the models in order to curb overall Medicaid spending. The Centers for Medicare & Medicaid Services (CMS) on Tuesday proposed a rule that […]

Washington State Targets Medicaid Shortfall, But Not in Time for Some SNFs

Two different legislative proposals in the state of Washington call for a change in how the state calculates Medicaid reimbursement for skilled nursing facilities. But the changes – if they take effect – may not be in time to save more facilities from closure, according to one trade group. Northwest News Network first reported on […]

With a ‘Shrink to Grow’ Plan Complete, a Strengthened Consulate Eyes Skilled Nursing Expansion

Stabilizing and turning around a single skilled nursing facility can take up considerable time and resources for any one provider. Turning around an operating company with more than 200 buildings and a multitude of internal systems takes even longer. Consulate Health Care needed multiple years. Chris Bryson who joined the Maitland, Fla.-based operator in September […]

Why a 10% Medicaid Boost Wasn’t Enough to Save Nursing Homes From Closure

The state of South Dakota earlier this year passed a significant increase to Medicaid reimbursement for nursing facilities in the state, prompted by a rash of closures. But even with the extra dollars -– the state in April authorized a 10% increase in Medicaid reimbursement for nursing homes, which translated to a roughly $8-per-day increase […]

Sharp Rise in Ancillary Medicare Advantage Benefits — from Adult Day to Home Care — Coming in 2020

Medicare Advantage plans are rapidly expanding the supplemental benefits recently approved by the federal government, with 116 plans offering more than one of these services for the 2020 contract year. Those supplemental benefits provide more options for care at home for beneficiaries — and could potentially represent paths away from the skilled nursing setting. In […]

LTC Looks to Offload Preferred Care Assets, Senior Care Centers Prevails in Long Lease Fight

LTC Properties, Inc. (NYSE: LTC) is still navigating the aftermath of bankruptcies with two of its skilled nursing operators — with plans to offload the assets operated by Preferred Care, and a potential end to the protracted Senior Care Centers fight on the horizon. The latter company, which declared bankruptcy in December of last year, […]

$240M Illinois Medicaid Funding Increase Remains Unclear: ‘It Could Be Eaten Up in Penalties’

Illinois lawmakers’ approval of a Medicaid reimbursement increase for skilled nursing facilities earlier this year came as welcome news to providers in a state notorious for its difficult operating environment. But key definitions related to the requirements for staffing are still being finalized, and the ramifications for the funding boost are still unclear. “The whole […]

Nursing Home Denials in CA Raise Concerns About Larger Move to Managed Medicaid

Managed Medicaid plans in California have, in some cases, denied coverage to patients for nursing facility care, raising concerns among long-term care advocates in the state about coverage by such plans. California Healthline, a publication of Kaiser Health News, reported the story earlier this week. California pays plans a monthly rate for every Medicaid beneficiary […]

$28.3M Financing for Skilled Nursing Campus; Shuttered Former Genesis SNF to Reopen Under New Owners

Walker & Dunlop provided $28.3 million in bridge financing for the acquisition of the 194-bed Pleasant Bay Campus in Brewster, Mass., which features skilled nursing and assisted living services The campus, operated by Point Group Care, includes the 59-bed assisted living facility The Woodlands at Pleasant Bay and the 135-bed Pleasant Bay Nursing and Rehabilitation […]

As Medicare Advantage Plans Slowly Migrate from RUG to PDPM, Providers Must Avoid Lost Payments

Most Medicare Advantage (MA) plans that used the old Medicare system for calculating reimbursement for skilled nursing facilities are moving to the new system along with the federal government — at least if the early weeks of the Patient-Driven Payment Model (PDPM) are anything to go by. That said, details on contracts and changes are […]

Receiver Files Lawsuit Against Former Welcov Execs, Seeking at Least $18M

The court-appointed receiver in the bankruptcy of Edina, Minn.-based Welcov Healthcare has sued two executives from the now-defunct skilled nursing operator, seeking at least $18 million. The Minneapolis Star Tribune first reported the news. Lighthouse Management Group filed suit against former Welcov CEO Paul Contris and company president Thomas Boerboom in Hennepin County, Minn., alleging […]

CMS Could Soon Crack Down on States’ Medicaid Payment-Boosting Programs for Nursing Homes

In multiple states, supplemental programs help skilled nursing facilities offset the low reimbursement for their services from Medicaid. But the federal government is starting to take a closer look at the programs, with an eye to increasing transparency, Andrea Maresca, senior vice president at the consulting firm Thorn Run Partners, said during a presentation on […]

Nursing Home Providers Sue Over NY’s Decision to ‘Damn the Torpedoes’ and Implement $246M in Medicaid Cuts

A coalition of nursing home providers in New York State on Thursday filed a lawsuit against the state’s Department of Health (DOH), alleging violations of federal and state law with regard to hundreds of millions in Medicaid funding cuts. “These rate reductions were motivated purely out of budgetary concerns, with no consideration for the residents […]

As Phase 3 Looms, Many Skilled Nursing Facilities Lack Key Required Staff

A new survey found that though antibiotic stewardship has increased at skilled nursing facilities across the country, there are still gaps with regard to the infection preventionist (IP) position -— even though that position is a key part of Phase 3 of the Requirements of Participation (RoPs) for SNFs, taking effect at the end of […]