Fewer than 20% of evaluated nursing homes made the list of “Best Nursing Homes” in U.S. News & World Report’s 2025 Best Nursing Homes rankings, out of nearly 15,000 facilities in the country. This includes those providing short-term rehabilitation, long-term care, or both. And, nearly half of nursing homes didn’t comply with federal regulation to […]
Category: Compliance
Uncertainty surrounding the information required for the new nursing home Medicare revalidation process has led to high levels of concern, particularly among for-profit operators, who view it as yet another punitive measure. Following letters from nursing home advocates about the rushed timing of the off-cycle revalidations, the Centers for Medicare & Medicaid Services (CMS) has […]
The long-term financial viability of nursing homes will be seriously challenged as operators face the fallout from the complete wind down of public health emergency (PHE) funds. This is especially true for nonprofit organizations, with many facilities unable to fund existing staffing levels. According to a report published in Health Affairs Covid-19 PHE funds allowed […]
Ahead of Tuesday’s presidential election, the two leading candidates appear to share some common ground regarding overall support for long-term care, including nursing homes, and their commitment to Medicare. However, a deeper look at their positions reveals differences that could, according to some, lead to changes in the nature of the Medicare program over time. […]
In 2025, the nursing home sector can expect several policy updates from the Centers for Medicare and Medicaid Services (CMS), Director Evan Shulman said on Tuesday. He highlighted the agency’s work on risk-based surveys to reduce delays and new consumer guides for which the agency is seeking feedback from nursing homes, among other initiatives. Speaking […]
While prior authorization has a legitimate role in Medicare Advantage coverage, the practice has expanded to the point of negatively affecting care. This aspect of MA needs to be right sized, and likely through legislation, nursing home leaders said. About 90%-plus of physicians, including those serving nursing home patients, have said that one or more […]
The Centers for Medicare & Medicaid Services (CMS) will no longer process optional state assessments (OSAs) after Oct. 1, 2025 for providers in states that are still transitioning to the Patient Driven Payment Model (PDPM). Moving ahead, CMS will not be involved in whether a state will continue to require the completion and submission of […]
On Wednesday, the Centers for Medicare and Medicaid Services (CMS) released plans to update the State Performance Standards System (SPSS) for the 2025 fiscal year. This will involve eliminating two measures from the previous year, introducing a new one, and revamping several others. A new addition to the SPSS, which is the federal agency’s rubric […]
A newly released study casts doubt on whether the shift to Medicare Patient Driven Payment Model (PDPM) succeeded in the goal of curbing so-called “upcoding” practices among nursing homes. Conducted by researchers from the University of Rochester and the University of Texas at Austin, the analysis spans seven years and found patterns of exploitation that […]
The Centers for Medicare & Medicaid Services (CMS) overstepped its authority in finalizing the federal nursing home staffing mandate, which “cannot stand” and should be set aside swiftly by a judge. This is the argument that the American Health Care Association, LeadingAge and other plaintiffs made in a Motion for Summary Judgment filed on Oct. […]
The Centers for Medicare & Medicaid Services (CMS) went over the off-cycle Medicare revalidation process for nursing homes in its latest open door forum on Thursday, its first in several months. About one-third of all providers will receive a letter from their Medicare administrative contractor (MAC) between this month and December requesting completion of the […]
Skilled nursing facilities need reasonable flexibility and additional support to meet the latest federal mandate – an off-cycle revalidation process for Medicare – for which nursing home advocates are seeking an extension. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a letter on Wednesday to the U.S. Department of Health […]
Nursing homes looking to best utilize QAPI, or the quality assurance and performance improvement program, should think beyond the obvious clinical compliance and care benefits to residents. QAPI is usually seen as a way to reduce falls or tighten up medication management, but operators can do a lot more with the data besides using it […]
Nursing homes must prepare for an off-cycle revalidation process being mandated by the Centers for Medicare and Medicaid Services (CMS), or risk losing billing privileges. With the extra paperwork, CMS aims to enhance the accuracy and transparency of Medicare enrollment information amid new reporting requirements finalized in 2023. The revalidation notices will be dispatched by […]
Vice President Kamala Harris shared a new proposal on Tuesday to require Medicare to cover the costs associated with in-home long-term care, potentially allowing seniors and individuals with disabilities to receive care in their homes rather than in skilled nursing facilities. The proposal could have broad appeal for middle-income Americans who don’t qualify for Medicaid. […]
For some nursing homes, quality assurance and performance improvement (QAPI) meetings serve merely as a checkbox for requirements, but they haven’t driven changes to improve care quality outcomes. On the flip side, however, other nursing homes are effectively using QAPI meetings to push for success in quality of care. Executives at these facilities emphasize that […]
Nursing homes and hospitals are developing closer ties and improving communication, and with this trend, admissions into nursing homes are expected to increase as rehospitalizations and excessive lengths of stay are also seen as declining. With rising acuity and staffing shortages of recent years, nursing homes have often been reluctant in admitting challenging cases that […]
The Centers for Medicare & Medicaid Services (CMS) released a draft Minimum Data Set (MDS) on Tuesday, and while the changes are minimal, clinical and reimbursement experts noted that they could lead to reduced control over certain quality reporting measures. However, the earlier-than-anticipated release also suggests that the federal agency aims to give operators a […]
For its Quality Reporting Program, the Centers for Medicare & Medicaid Services (CMS) is exploring the possibility of expanding nursing home data collection and submission to all residents, regardless of payer type. Officials heard feedback on the challenges and benefits of such a move during a listening session held on Tuesday. If the federal agency […]
As states in Hurricane Helene’s path grapple with its devastating effects days after it made landfall in Florida Thursday evening, nursing home operators are dealing with significant repair and maintenance challenges that could last a while – particularly in states like North Carolina. Damage to transportation, power and utilities could make recovery in some states […]
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