The Centers for Medicare & Medicaid Services (CMS) is proposing to expand the Skilled Nursing Facility Quality Reporting Program (SNF QRP) so that reporting requirements would apply to all payer types, not just Medicare residents. Extending this will create substantial administrative, staffing and financial burdens for nursing homes, leaders said. CMS’s proposal to require admission […]
The medical director can make or break a nursing home’s path to quality care, and it’s a role that has drastically evolved over the last decade to bridge the gap between state survey agencies, staff and residents, while serving as the go-to resource for understanding enforcement cycles. In worst-case scenarios, medical directors serve as key […]
Coding for treatment of certain conditions has surged substantially, and as the Centers for Medicare and Medicaid Services (CMS) pulls closer to finalizing the Skilled Nursing Facility Prospective Payment System (SNF PPS) in July, the agency will be looking to see if these increases reflect legitimate changes in resident complexity and care practices rather than […]
The Centers for Medicare and Medicaid Services (CMS) is adding electronic prior authorization to the Health Tech Ecosystem, bringing electronic health record (EHR) vendors, health systems, hospitals, physician practices and digital health developers to the table with payers. The idea is to make a unified coalition aligned around making electronic prior authorization work end-to-end on […]
The all-or-nothing nature of the Centers for Medicare and Medicaid Services (CMS) quality audits means nursing homes could face reductions in reimbursement – and, in the case of hybrid measures such as antipsychotic use, potential star rating downgrades – if they fail to comply with or fully respond to audit requests, experts say. This comes […]
Pennsylvania lawmakers have introduced new emergency preparedness legislation aimed at making nursing home evacuations easier for first responders. State Sen. Steve Santarsiero and Rep. Tina Davis introduced the bill following explosions at Saber Healthcare Group’s Bristol Health and Rehabilitation in the state, which left three dead and another 20 people injured – at the time, […]
The fight over the federal nursing home staffing mandate isn’t over yet – it might be entering its next phase, according to Jonathan Blum, former COO and principal deputy administrator at the Centers for Medicare and Medicaid Services (CMS), who said the idea of having such requirements is certainly still circulating among federal officials. While […]
Following government scrutiny of its billing practices, nursing home giant PACS Group (NYSE: PACS) is entering a new phase of growth defined by strengthened compliance, according to CEO and co-founder Jason Murray. After its initial public offering in 2024, the company was thrust into an investigation that prompted it to reassess internal practices. Today, there […]
Quality Assurance and Performance Improvement (QAPI) programs are invaluable for incorporating person-centered care in nursing homes. However, the concept is not clearly defined by government agencies, making it difficult for facilities to implement. The development of interactive training modules as well as broader QAPI initiatives on topics like conflict resolution are commonly used by nursing […]
When assessing a nursing home’s risk for errors on surveys, the Centers for Medicare and Medicaid Services (CMS) and state survey agencies are increasingly focused on patterns, system reliability and whether failures could reasonably recur at a facility. This is according to former multi-state surveyor Linzie Bugg and registered nurse Amanda Odom, who said during […]
Infection control and antimicrobial stewardship in nursing homes go hand in hand. And yet, the two are often treated as separate efforts. Many clinicians believe they should be integrated together, but doing so will require unique training to equip staff with the knowledge and tools to build effective, data-driven stewardship programs that cover both areas […]
The Centers for Medicare & Medicaid Services (CMS) is proposing a nationwide expansion of the Comprehensive Care for Joint Replacement (CJR) model, with the goal of driving more coordinated care for people receiving hip, ankle and knee replacements – including through skilled nursing facility services. This proposed expansion would build on the original CJR model, […]
Institutional Special Needs Plans (I-SNPs) can increase on-site care and reduce hospital use for nursing home residents, policy analysts with a nonpartisan agency that advises the U.S. Congress on Medicare policy said Friday, cautiously endorsing expansion of the I-SNP footprint in the sector – currently used by only about a third of nursing homes. The […]
Indiana nursing homes are owed $462 million in back payments under the state’s Medicaid program due to delays caused by the transition to managed care, which has created administrative complexities. The issues stem from changes to the PathWays for Aging program, which shifted long-term services into managed care and resulted in ongoing payment delays for […]
After years of workforce instability, skilled nursing operators are finally seeing signs of progress in staffing – yet new policy developments and ongoing state level mandates threaten to complicate that recovery in 2026. Sector leaders say declining agency use, stronger hiring pipelines, and expanded training programs helped stabilize staffing in 2025. However, regulatory pressures – […]
The Centers for Medicare and Medicaid Services (CMS) recently opened applications for the Long-Term Enhanced ACO Design model (LEAD) and posted more guidance for prospective participants. The highly anticipated model replaces ACO REACH, which will be discontinued at the end of this year. While LEAD offers promising opportunities and improvements, it’s highly complex and demands […]
Nursing homes were deprived of nearly $500 million in Medicaid funding intended for resident care, a Utah state audit found, with the funds instead retained by hospital-affiliated entities as administrative fees. The issue centers on the Skilled Nursing Facility Upper Payment Limit (SNF UPL) program in the state, which is designed to supplement Medicaid payments […]
The Centers for Medicare & Medicaid Services (CMS) on Friday introduced a set of revisions updating survey procedures to require more consistent onsite timelines and clearer revisit protocols, expand enforcement through strengthened Civil Money Penalties (CMPs), and refine definitions of Immediate Jeopardy (IJ) to better identify and respond to the most serious risks to residents. […]
The Centers for Medicare and Medicaid Services (CMS) on Thursday issued its Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, increasing Medicare rates by 2.4%. The federal agency is also proposing to remove two measures from the SNF Quality Reporting Program (QRP). The 2.4% increase is based on the proposed SNF market basket […]
With reimbursement for brand name drugs sharply decreasing under the Inflation Reduction Act, long-term care pharmacies are having to make difficult decisions that will have a lasting impact on nursing home residents. The law disrupts long-term care pharmacies’ business model, capping payments for certain high-use brand name drugs through maximum fair price rules, said Alan […]
