Omega CEO Pickett: Medicaid-Focused Model Can Work in Skilled Nursing

With capital chasing upside and new development dominated by high-end “medical resorts,” the availability of long-term care beds has emerged as a big-picture issue for the skilled nursing industry. While it may not be a nationwide problem just yet, certain markets — from Wisconsin to California — have begun to show the early signs of […]

Record-Setting $1.3B Nursing Home Fraud Case Ends in 20-Year Prison Sentence

Philip Esformes, who used to control a network of skilled nursing and assisted living facilities running from Miami to Chicago, was sentenced to 20 years in prison on Thursday. The legal publication Law360 first reported the news. The U.S. Justice Department called the case, which resulted in 20 guilty verdicts in April, the largest single […]

Skilled Nursing Sell-Off in Texas Goes Beyond Payment: ‘The Problem is Not the Medicaid Rate’

Texas’s failure to pass a program to increase Medicaid payment to skilled nursing facilities was the latest step not taken in improving the reimbursement in the Lone Star State. The legislation, which would have set up a long-term care quality provider participation program (QPPP) to funnel additional compensation to SNFs for meeting certain quality metrics, […]

Voters Could Decide on Medicaid Nursing Home Rate Increases in Massachusetts

A ballot initiative that would overhaul the way Massachusetts’s Medicaid program pays for nursing home services last week moved one step closer to reaching voters. The office of state attorney general Maura Healey certified a nursing home reimbursement proposal among other potential ballot questions for Bay State voters to consider in 2020, local NPR station […]

CMS Expands Power to Ban Providers with ‘Problematic’ Affiliations from Medicare, Medicaid

The federal government on Thursday finalized a rule that will expand its power to remove potentially unscrupulous health care providers from Medicare and Medicaid eligibility. Under the new final rule, the Centers for Medicare & Medicaid Services (CMS) can kick providers out of the programs if they have a previous affiliation with a banned organization, […]

CMS Chief Medical Officer: More Changes Coming to Nursing Home Compare, Quality Measures

The past several years have seen sweeping overhauls of nursing home enforcement on the federal level, and the Medicare program’s top clinical officer says her agency isn’t done beefing up its efforts. Dr. Kate Goodrich, the chief medical officer for the Centers for Medicare & Medicaid Services (CMS), promised that more changes are coming to […]

Managed Medicaid Could Compound SNF Headaches in Kansas as Aetna Pledges Improvements

After health care providers reported a range of issues with reimbursement, one of Kansas’s three managed Medicaid insurance companies promised improvement at a recent state government hearing. “Clearly, the feedback we’ve received and some of the issues that have been brought to our attention and some of the issues we’ve seen internally have been extremely […]

State Targets Low-Occupancy Nursing Homes for Steep Medicaid Cuts

Lawmakers in the state of Connecticut have targeted nine facilities for major Medicaid cuts due to low occupancy, raising concerns about access issues from operators and employees alike — and highlighting the occasionally paradoxical relationship between skilled nursing usage and funding. The nine properties face a total of $6 million in lost Medicaid reimbursements, the […]

Despite Pressures, ACOs’ Three-Day Stay Waivers Could Emerge as Skilled Nursing Secret Weapons

Among the new payment models sweeping the skilled nursing industry, accountable care organizations (ACOs) tend to vex nursing home operators the most. These groups, which encourage cost savings by holding providers up and down the continuum accountable for overall health spending, are typically seen as length-of-stay depressants. The hospitals and physician organizations that generally lead […]

A Year After SNF Closure, Illinois’s Medicaid Issues Lead to Bankruptcy for Non-Profit Operator

Because of delays by the Illinois government in processing Medicaid coverage applications, the non-profit operator of a skilled nursing facility that closed a year ago is now declaring bankruptcy. The State Journal-Register reported the news August 16th. The state of Illinois made headlines last year for a multi-million Medicaid eligibility backlog, and it already had […]

Omega Offers Details on $735M Skilled Nursing Pickup, Ongoing Daybreak Woes

Omega Healthcare Investors (NYSE: OHI) made a major splash this week with the announcement of a planned $735 million skilled nursing acquisition, though executives also reported that a troubled tenant in Texas hasn’t generated any revenue for the real estate investment trust (REIT) yet this quarter. Daybreak Venture met its rent obligations under a deferral […]

Omega to Buy 58 Skilled Nursing Facilities in $735 Million Deal

Omega Healthcare Investors (NYSE: OHI) on Tuesday announced plans to pick up 58 skilled nursing facilities in a 60-building deal valued at $735 million. The Hunt Valley, Md.-based real estate investment trust (REIT) agreed to the deal on July 26, Omega reported this week, though it remains subject to approval by the Department of Housing […]

Under PDPM, Benefits of In-House Medicare Advantage Plans Will Go Beyond Money

Forward-thinking skilled nursing providers have increasingly warmed to the idea of starting a special kind of in-house Medicare Advantage plan in order to take more control over their reimbursements in an uncertain environment. But the strategies that operators must adopt to succeed with Institutional Special Needs Plans (I-SNPs) also fit seamlessly into preparations for the […]

Medicare Advantage Hasn’t Always Prioritized Skilled Nursing — But That’s Changing

If skilled nursing facilities want to improve their relationship with managed care payers — particularly the ever-expanding Medicare Advantage plans — they have to ensure that they understand the payers’ pain points. And they have to battle the reality that in the Medicare Advantage world, post-acute barely registers on insurers’ radar screens because it’s a […]

Abuse Reporting and Owner Background Checks Loom Large in Elder Justice Hearing

Background checks for staff and better reporting for nursing home abuse loomed large in a U.S. Senate Committee on Finance hearing held Tuesday, with consumer advocates and industry representatives confirming the findings of a new report that revealed oversight gaps by the Centers for Medicare & Medicaid Services (CMS) around nursing home abuse. The report, […]

CMS’s Regulatory Delay: What’s In, What’s Out, and Why Nursing Homes Could ‘Substantially’ Reduce Costs

Skilled nursing facilities could see relief from regulatory burdens if a proposed rule from the Centers for Medicare & Medicaid Services (CMS) takes effect, and according to the agency, it could lead to millions in savings. Specifically, the rule would overhaul multiple requirements and delay the implementation of regulations related to the Quality Assurance and […]