CMS Chief Verma ‘Spending a Lot of Time on Nursing Homes’

The administrator of the Centers for Medicare & Medicaid Services (CMS) placed nursing homes among her top areas of focus for the months to come, though she provided scant few other details during a wide-ranging press conference this week. “I’m spending a lot of time on nursing homes,” Seema Verma said in a Wednesday afternoon […]

Nursing Home Strike Threat Drives Momentum for Medicaid Rate Boosts

The looming specter of a strike at nursing homes in Connecticut has prompted leaders in the state to support increases to daily Medicaid rates for institutional care. Connecticut Gov. Ned Lamont this week expressed support for three Medicaid rate boosts through 2021, a move that the CT Mirror — which first reported the news — […]

Florida’s New Medicaid Math Creates Nursing Home Winners, Losers

Florida’s new Medicaid prospective payment system for nursing homes, which took effect in October of last year, has created winners and losers among properties across the state, according to a new analysis by the USA Today Network — Florida. The PPS is designed to incentivize and reward skilled nursing facilities that make improvements in care […]

$15 Minimum Wage Creates Fault Lines Between SNFs, Employees in CT as Strike Threat Remains

A proposal to increase the minimum wage in Connecticut has employees hopeful for higher salaries — and operators worried about even tighter margins moving forward. Nursing care providers in the Constitution State, already facing the threat of a strike by about 2,500 employees at 20 facilities, have become increasingly concerned about the potential for a […]

Sitting Out Bundled Payments Could Leave Skilled Nursing Providers Far Behind

For many skilled nursing providers, the launch last week of the 2020 application period for the government’s flagship bundled-payment program was low on the list of priorities. After all, under the new Bundled Payments for Care Improvement Advanced (BPCI Advanced) model, nursing homes can’t be episode initiators, meaning hospitals and other acute-care providers are the […]

Kansas Cracks Down on Nursing Home Owners’ Finances in Wake of Skyline Collapse

The state of Kansas is set to implement stricter vetting standards for nursing home owners and investors in the wake of several high-profile receivership cases over the past year. Passed with near-unanimous support from the Republican-controlled legislature and the approval of the Democratic governor, the new law will require potential nursing home owners to submit […]

Oklahoma One Step Closer to Boosting Medicaid Rates for Nursing Homes

Oklahoma moved one step closer to boosting Medicaid payments for skilled nursing facilities, with Senate Bill 280 ready to proceed to the Senate for final approval after some floor amendments. Tulsa World first reported the news. Oklahoma is proactively trying to bolster its Medicaid rate, which ranks among the lowest in the country. Several cities […]

‘Medicare for All’ Plan Would Expand Coverage for LTC — But Nursing Homes Stay Under Medicaid

Sen. Bernie Sanders this week introduced a bill to create a single-payer health care system for the U.S., a plan that includes long-term care in its scope — but keeps coverage for institutional nursing home care under Medicaid. The legislation would ensure that the so-called “Medicare for All” plan would include benefits for at-home long-term […]

CMS Launches $1M AI Development Challenge Aimed at Predicting Unnecessary SNF Admissions

The Centers for Medicare & Medicaid Services (CMS) on Wednesday announced an open challenge to tech providers, dangling $1 million for the algorithms that can best predict potential admissions to skilled nursing and other health facilities. With the Artificial Intelligence Health Outcomes Challenge, CMS hopes to entice tech firms and individuals to compete against each […]

OIG Takes Back $48M in Fraudulent Medicaid Payments as Nursing Homes Lead List of Open Cases

Despite the second straight year of declines in overall recoveries, the Department of Health and Human Services’ (HHS) top watchdog arm took back nearly $50 million in Medicaid reimbursements from nursing homes in fiscal 2018. The HHS Office of the Inspector General (OIG) this week reported a haul of $48.7 million from nursing providers accused […]

Crackdown on Improper Medicare SNF Payments May Cost More Than It Saves

The Department of Health and Human Services (HHS) made a splash last month when it claimed that skilled nursing facilities received $84 million in Medicare payments for treatments that didn’t qualify — but now a group of doctors claims that the proposed cures might be worse than the disease. Writing in a blog post for […]

Ensign Group Completes Five-Year OIG Oversight Agreement

Leading skilled nursing provider The Ensign Group (Nasdaq: ENSG) on Thursday announced that it has successfully completed a five-year Department of Health and Human Services (HHS) oversight period. The Mission Viejo, Calif.-based company initially entered into a corporate integrity agreement (CIA) with the HHS Office of the Inspector General (OIG) back in October 2013; at […]

Avoiding Million-Dollar Medicaid Eligibility Mistakes in Nursing Facilities

Skilled nursing operators can’t control day-to-day Medicaid rates in their states, but they do have a broad toolbox that can help them avoid eligibility errors and oversights that can cause millions in losses. In an era of constricted Medicaid reimbursements, frontline staff can still play a crucial role in maximizing dollars, sb2 Inc. CEO and […]

Lawmakers Again Take Aim at ‘Observation Stay’ Rules for Medicare SNF Coverage

A bipartisan coalition of federal lawmakers this week took another stab at clarifying the rules regarding a frequently confusing aspect of skilled nursing coverage under Medicare. Under the terms of the proposed legislation, the Improving Access to Medicare Coverage Act of 2019, so-called “observation stays” would count toward the three days of inpatient acute care […]

Texas Floats Plans to Boost Medicaid Funding Through SNF Quality Program

After a high-profile bankruptcy in December of last year, Texas now has two bills that aim to provide some Medicaid reimbursement relief to skilled nursing providers in the state. The bills, Senate Bill 1050 and House Bill 3342, would establish a long-term care quality provider participation program (QPPP) in the state that provides additional compensation […]