Nursing Home Reimbursement Pressure ‘Flat Out Profound,’ Necessitating Innovative Models

It’s becoming harder than ever to operate standalone skilled nursing facilities amid inadequate government funding, and innovative business models that deal with challenges, especially those related to staffing, have and will be borne from necessity. “Innovative models are going to present themselves in some way to stop this train,” said Dan Hermann, president and CEO […]

In Suing Ohio Medicaid Department, Nursing Home Associations Allege Facilities Were ‘Significantly Shortchanged’

Nursing home associations in Ohio have sued the state Department of Medicaid last week over a Medicaid rate that does not match what’s needed to meet quality incentives. Ohio’s rebasing process splits Medicaid funding into two categories, with 60% based on meeting certain quality incentives and 40% reserved for the “base rate,” or a calculation […]

‘Elephant in the Room’: Medicare Advantage a Huge Factor in CCRC Decision Making Around Nursing Home Services

Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) to provide such labor intensive post-acute care. CCRCs have to ask themselves some hard questions when it comes to what services they can reasonably offer, and if it’s worth it to keep open […]

Why the Medicaid Battle is Leading to More Quality-Based Nursing Home Payments

In the midst of lagging Medicaid reimbursements, more nursing providers are pushing states to launch quality incentive programs that are designed to enhance care and reward high-performing long-term care providers. Twenty-four states already have them in place, and the latest to join this trend is Pennsylvania. And to that end, nursing home providers in Pennsylvania […]

Some State Legislators Race to Add Funding as ‘Nursing Home Deserts’ Expand

Rural and small market areas continue to experience growing “nursing home deserts,” an increasing crisis for local officials and beneficiaries facing access issues. In Nebraska, for one, state data shows 29 facilities closed their doors in the past three years, leaving pockets of “nursing home deserts” across 20 counties, according to a report from KETV […]

‘Really Hard Time’: NY Nursing Home Sector, Union Demand $810M in Medicaid Funds, Cite Payroll Shortfalls

Nursing home owners and advocates have long decried low Medicaid reimbursements to the sector across the U.S. And now leaders in New York state – home to one of the largest number of facilities – are uniting to forcefully demand change. Much like the rest of the country, closures, especially in Upstate New York, have […]

Inside the CMS Policies That Could Improve Care, Payments for Dual-Eligible Nursing Home Residents

Given that a vast majority of long-stay nursing home residents are dual eligible for Medicare and Medicaid, residents and facilities alike can reap financial benefits while improving quality of care and reducing administrative burdens if federal and state policies better enabled a value-based care model that integrated the experiences of dual eligibles. This is the […]

Medicaid Funding Suspended for Two More Nursing Homes in NJ, Owners Linked To Alleged Fraud

Two more nursing homes in New Jersey have their Medicaid funding suspended following allegations of massive fraud by the owners related to their New York facilities. Deptford Center for Rehabilitation and Healthcare, and Hammonton Center for Rehabilitation and Healthcare will lose their Medicaid funding on May 24, according to the Office of the State Comptroller […]

OIG Plans To Audit Nursing Home Survey Practices This Year – With Results Expected in 2025

The Office of the Inspector General (OIG) will be auditing nursing home survey practices this year with results expected in 2025, following concerns that third-party contractors may not have sufficient oversight in the space. OIG suggested closer scrutiny of the Centers for Medicare & Medicaid Services (CMS) regulatory practices when it came to surveys, given […]

KFF: Nursing Home Deficiencies Jumped Almost 10% Since 2015 and Staffing Levels Are To Blame

Deficiencies in nursing homes, both on average and those deemed more serious, have increased over time – partly as a result of decreasing staffing levels. Between 2015 and 2023, facilities with serious deficiencies, or violations of federal regulations, increased from 17% to 26%, according to a data note published on Friday by KFF. The average […]

When Disparities and Differences in Resources Abound, Medicaid Acts as Stopgap

The need for Medicaid as stopgap coverage for long-term care is more apparent when looking at differences in race, gender and ethnicity, and rural versus urban status of the residents. This is according to an analysis conducted by ATI Advisory, which identified the impact of disparities and differences in resources – finances, insurance and social […]

Comprehensive Healthcare Legal Saga Culminates in Acquittal of Individuals, Guilty Verdict for Corporate Defendants

Pennsylvania operator Comprehensive Healthcare Management Services was found guilty in a sprawling health care fraud case, following a five-week federal trial in Pennsylvania, involving two of its facilities. Brighton Rehabilitation and Wellness Center and Lebanon Rehabilitation and Wellness Center were found guilty of making false statements in connection with the payment of health care benefits […]

Closing the Medicaid Gap Is Just the First Step, as Nursing Homes Fight for Predictable Reimbursement

Nursing homes and the state associations that represent them continue to put pressure on legislators to match Medicaid rates with rising costs, and change how often rebasing occurs to give operators a more even playing field. In a lot of cases, Medicaid increases helped lessen the gap between costs and stagnant rates. But, legislators still […]

‘Tougher Every Day’: Nursing Home Operators, CCRCs Weigh in on Future of Skilled Nursing

Operating a skilled nursing facility today is considered a difficult business with regulations and reimbursement woes making the space “tougher every day.” As a result, some operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. This dire view of […]

Nursing Home and CCRC Spending Grew 5.6% to $191.3B in 2022 – After Dropping 7.8% in 2021

Nursing homes and continuing care retirement communities (CCRCs) made up $191.3 billion of national health expenditures in 2022, an increase from $181.1 billion in 2021, reaching levels close to the onset of the Covid-19 pandemic. Pre-pandemic, such expenditures sat between $162 billion and $174.1 billion between 2016 and 2019, according to a survey published by […]

Repositioning Nursing Homes For Acuity, More Closures, Less Deal Making Expected in 2024

As the skilled nursing industry heads toward a new year with continued labor shortages and reimbursement gaps, service repositioning and closures among operators are expected trends for the space. And although there are signs of positivity in the form of increased Medicaid reimbursement in some states, extensive rural closures are creating “nursing home deserts” and […]

Dealmaking In Nursing Homes: Bubble Will Burst As States Aim for Budget Neutrality During Medicaid Recalibration

In adjusting to new case-mix systems under the Patient Driven Payment Model (PDPM), the changes to reimbursement rates might be more widespread and large-scale than anticipated, posing financing threats to the nursing home sector because lenders are basing loans on rate projections that are expected to be scaled back. The goal of budget neutrality – […]