Growth in Medicare Advantage Spending Far Outpaces Traditional Medicare

The growth in overall spending on nursing homes in the United States slowed for the second consecutive year in 2017, according to the latest analysis from the Centers for Medicare & Medicaid Services (CMS) — while Medicare Advantage spending skyrocketed. All payers spent $166.3 billion at nursing care facilities and continuing care retirement communities (CCRCs) […]

Maryland Provider Reaches $2M Settlement Over False Discharge Claims

An extended battle between a now-defunct nursing home operator and the state of Maryland reached a conclusion this week with a $2.2 million settlement. Neiswanger Management Services (NMS) agreed to pay that amount to dismiss allegations that it had improperly discharged Medicare residents and falsely billed the state’s Medicaid program, Maryland Medical Assistance. Back in […]

Medicaid Overpays Nursing Homes by $1B Per Year, Study Suggests

Nursing home providers typically operate on razor-thin margins, but a new study suggests that the Medicaid program may be overpaying operators by billions of dollars per year. A pair of economists from the University of California, Los Angeles and the University of Georgia this month published an extensive analysis of Medicaid spending in nursing homes, […]

Oklahoma Cities Snap Up Nursing Homes in Gamble for Federal Funds

Several small cities in Oklahoma now hold the licenses to operate dozens of nursing homes in the state, in the hopes of getting funds from a federal bonus payment program offered through the Centers for Medicare & Medicaid Services (CMS), Oklahoma Watch reported this week. Licenses for 46 nursing homes in the state are now owned by […]

Low Medicaid Rates Cause Skilled Nursing Crisis in Washington State

It’s unlikely that the state of Washington intended to put its skilled nursing facilities on the brink of disaster when it overhauled its Medicaid system in 2016, but leaders of both LeadingAge Washington and the Washington Health Care Association (WHCA) said that’s exactly what has occurred as providers across the state try to keep their […]

Data Drives Skilled Nursing Referral Partnerships, But Residents Ignore It

As referral networks narrow and skilled nursing providers feel increased pressure to prove their worth to hospitals and doctors, one government agency says residents still frequently miss the highest-quality options in their own areas. In its most recent report to Congress, the Medicare Payment Advisory Commission (MedPAC) asserts that many hospitals discharge post-acute care patients […]

Nursing Homes Settle $24M Medicaid Lawsuit in Rhode Island

Rhode Island reached a settlement with 59 nursing homes that sued the state over Medicaid reimbursement cuts, averting a potential $24 million cost to the state over three years. Under the terms of the consent order, Medicaid rates paid to the state’s nursing facilities — for both managed care and fee-for-service — will increase by […]

Nursing Homes Fight Back Against Medicaid Cuts with Lawsuit

A group of Montana nursing homes and assisted living facilities sued the state Monday to stop cuts to Medicaid reimbursements, The Associated Press reported. As part of spending decreases throughout the state government intended to address a budget shortfall, Montana’s Department of Public Health and Human Services (DPHHS) cut Medicaid provider reimbursement rates in January. In […]

Azar Touts PDPM But Warns ‘Entrenched Players’ of Challenges Ahead

Health and Human Services Secretary Alex Azar on Tuesday trumpeted the new payment model for skilled nursing facilities in a speech before a prominent trade group, positioning the plan as one piece of a larger change in the way the government pays for health care. The new Patient-Driven Payment Model (PDPM) incorporates the dual goals […]

Preferred Care Looks to Settle Lawsuits to Speed Up Bankruptcy

Embattled skilled nursing provider Preferred Care has asked a federal bankruptcy judge to approve a settlement regarding allegedly falsified Medicare and Medicaid claims. Settling the pair of federal whistleblower lawsuits, filed in 2016 and 2017, would help accelerate Preferred Care’s Chapter 11 bankruptcy process, the provider argued in a filing submitted last week. Westlaw Practitioner […]

Report Accuses New Mexico of Nursing Home Woes as Medicaid Lags

The state of New Mexico ranks at the bottom in terms of serious skilled nursing deficiencies per facility, according to a recent analysis conducted by a pair of news organizations. Out of the 74 facilities in the state certified by the Centers for Medicare & Medicaid Services, 36 had “serious deficiencies” between 2015 and 2018, […]

Proposed Medicare Change Would Create Long-Term Care Benefit

A federal lawmaker on Wednesday rolled out a plan to provide a long-term care benefit as part of Medicare, citing the aging U.S. population and skyrocketing costs. Rep. Frank Pallone, a New Jersey Democrat, unveiled the Medicare Long-Term Care Services and Supports (LTSS) Act, a discussion draft of a bill that would expand Medicare coverage […]

HHS, CMS Object to Ownership Transfers in Orianna Bankruptcy

The Department of Health and Human Services (HHS) filed an objection to Orianna Health Systems’ bankruptcy plan, bringing the case into unsettled legal terrain. U.S. Attorney Erin Nealy Cox this week argued that HHS and the Centers for Medicare & Medicaid Services (CMS) have the ultimate control over the legal issues surrounding the transfer of […]

Operators See Opening to Shape Managed Care Policy in States

Managed care is on the rise in both Medicare and Medicaid, but skilled nursing and long-term care (LTC) providers don’t necessarily need to play catch-up. In fact, they have room to influence the direction of managed care in their states, according to a panel at the National Investment Center for Seniors Housing & Care (NIC) […]

New Therapy Payments a ‘Game Changer’ for Skilled Nursing Industry

Changes to the way Medicare reimburses providers of therapy services will change the game for skilled nursing operators, at least according to one industry analyst. The Resident Classification System, Version I (RCS-I) will replace the current fee-for-service Medicare therapy structure with a model that more closely tracks with larger trends toward value-based services, rewarding providers […]

Louisiana Rejects Proposal to Shift Skilled Nursing Residents to Home Care

The Louisiana Legislature on Tuesday rejected a bill that would have shifted the state’s long-term Medicaid model to a managed care system in an attempt to move more skilled nursing residents to the home-care setting. The Senate Health and Welfare committee voted down Senate Bill 357 in a 6-2 vote, The Advocate of Baton Rouge, La. reported. The bill […]