PDPM’s Effects Could Stretch Far Beyond Medicare for Skilled Nursing Facilities

On paper, the Patient-Driven Payment Model (PDPM) will only affect one pillar of the payment equation for skilled nursing facilities. But as players start to unpack the coming rule changes, PDPM’s reach begins to extend far beyond Medicare. Medicare Advantage and Medicaid frequently base rate calculations on the existing Medicare structure, a pair of experts […]

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 […]

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 […]

Trump Budget Plan Would Cut $845B from Medicare, $241B from Medicaid

The White House on Monday released a budget proposal that would substantially slash Medicare and Medicaid spending over the next decade. In part by adopting a site-neutral payment model for post-acute care under Medicare and converting the Medicaid system to block grants, the federal government would end up gutting more than $1 trillion from the […]

As Medicaid Rates Lag Behind Costs, Unpaid Nursing Home Bills Pile Up

Across the U.S., Medicaid rates tend to fall short of the cost of nursing home care for beneficiaries. In the state of Massachusetts, the financial pressures have rendered many skilled nursing facilities unstable — and forced many of them to close. The trend has also forced many of them to leave bills unpaid, which spreads […]

CMS to Crack Down on Staffing, Separate Short- and Long-Term Stays in SNF Star Rating Overhaul

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced stricter standards for its consumer-facing nursing home ratings, including a lower threshold for staffing penalties and new separate ratings for short-term and long-term stays. Starting April 24, CMS will automatically hand out one-star staffing ratings to buildings that have four or more days in […]

NYT: Nursing Home Closures Hit Rural America Amid Financial Hardship

The New York Times covered the wave of rural nursing home closures, which come amid financial problems and aging Americans’ changing preferences, in a deep dive published Monday. The article zeroed in on the closure of a nursing home in Mobridge, S.D., which was taken over by Black Hills Receiver after former operator Skyline Healthcare […]

Diakonos, Leo Brown Mix Post-Acute with Private Pay at New $15M Skilled Nursing Facility

In an era of tight finances and legal caps on the number of beds, new skilled nursing developments are few and far between — with most of the action in recent years focused on higher-end, post-acute rehab facilities. The Diakonos Group’s latest development, a $15 million skilled nursing facility in Tulsa, Okla. with a total […]

Vanguard Healthcare Settles Medicare, Medicaid Fraud Claims for $18 Million

A Tennessee-based skilled nursing provider this week agreed to pay the federal government $18 million in order to resolve claims of Medicare and Medicaid fraud. Vanguard Healthcare, LLC of Brentwood, Tenn. — along with several of its affiliated firms — reached the deal with the Department of Justice, which accused the provider of providing “grossly […]

Managed Medicaid Poised to Threaten Skilled Nursing Facility Payments, Census

Skilled nursing facilities are familiar with the headaches of dealing with managed Medicare. But the rise of managed Medicaid could cause just as many headaches for providers — if not pose outright threats to their financial wellbeing. That’s according to a panel of experts at the National Investment Center for Senior Housing and Care (NIC) […]

Paul Ryan: Medicare Advantage is the Future of Medicare, and Medicaid Reform Will Return

Public-private partnerships will form the basis of comprehensive Medicare reform as the baby boom population ages, former Speaker of the House Paul Ryan predicted Thursday morning in remarks at a major skilled nursing and senior housing industry conference. “I believe the future for Medicare is in the Medicare Advantage type of space,” Ryan, a Wisconsin […]

Spending Growth for Skilled Nursing Facilities to Lag Behind Home Health Care

Total spending on nursing care facilities will grow by 5.4% through 2027, according to a new analysis from the Centers for Medicare & Medicaid Services (CMS) — but that figure still lags behind the rate increase for home health agencies. Overall spending on medical care at skilled nursing facilities and continuing care retirement communities (CCRCs) […]

Medicaid Pressures, Worker Shortages Lead to SNF Closure Wave in Wisconsin

Nursing homes in Wisconsin are blaming the state’s low Medicaid reimbursements for a wave of nursing home closures and persistent financial struggles, Wisconsin Public Radio reported earlier this month. Nursing home advocates are asking lawmakers in the state to invest $83.5 million in the next two-year budget as a result, the media organization reported. The […]

Why Short-Term Rehab Alone Might Not Sustain Skilled Nursing

A consulting firm that offers services across the health care spectrum sees opportunity for growth in skilled nursing, though the leader of its SNF practice believes that the industry must expand beyond short-term rehab to survive. The Wayne, Penn.-based McBee plans to look at both hires and potential acquisitions as it tries to bolster its […]

Oklahoma Joins Growing List of States Seeking More Nursing Home Funding

Three bills in the Oklahoma Legislature would increase funding for skilled nursing facilities while mandating a staffing increase, adding the Sooner State to a growing list of U.S. states that are trying to address funding shortfalls for nursing homes. The Oklahoman reported the news. On average, the state pays about $23 less than the cost […]

South Dakota Nursing Home Leaders See ‘Statewide Disaster’ Without Medicaid Increase

Nursing homes in the state of South Dakota are facing a $42 million annual shortfall in Medicaid reimbursement, which has led to the closure of several facilities. Without an increase, industry leaders said, the closings could lead to “statewide disaster.” The Argus Leader first reported the story. Nine nursing facilities have already closed, two are […]

CBO: Nursing Homes Account for 15% of All Medicaid Spending as Aging Population Drives Costs

Programs for Americans aged 65 and older will account for nearly half of all the federal government’s non-interest spending in the next decade, a new report from the Congressional Budget Office found, as the baby boom population continues to age into both Medicare and certain Medicaid benefits. Medicare, Medicaid, and Social Security spending will balloon […]

Report Revives Potential for Massive Medicaid Cuts Through Block Grants

A plan to fundamentally change the way the federal government funds Medicaid — which could lead to hundreds of billions in cuts — may be back on the table after seemingly dying two years ago. The Trump administration is currently mulling ways to convert Medicaid to a block-grant system, Politico reported late last week, reviving […]