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 […]

HHS Secretary Wants Providers to Take Amazon, Yelp’s Lead

If Health and Human Services secretary Alex Azar has his way, the health care consumer of the future will select providers the way they currently decide where to eat or which knockoff iPhone charger to buy. “Imagine a day when health care delivery in the United States functions the way other parts of our economy […]

Industry Responds to Democrats’ Call for Skilled Nursing Scrutiny

In a Valentine’s Day letter to top health officials, a group of influential Senate Democrats asked the Centers for Medicare & Medicaid Services (CMS) to reconsider certain rollbacks of nursing home regulations. In response, a leading industry group on Wednesday wrote back to the senators to clarify and rebut some of their points. “We think […]

‘Avoidable’ Nursing Home Discharges Might Be Hard to Avoid

Keeping nursing home residents out of the hospital can save them from the risks associated with both the transition to the hospital and the hospitalization itself — while also preventing reimbursement penalties. But doing that in the nursing home setting is more complicated than it might seem, according to a study from the Indiana University […]

Assuming Risk Key to Medicare Savings Under New Payment Models

Accountable care organizations (ACOs) only generate savings for the government if they accept risk, according to an analysis from the Kaiser Family Foundation. ACOs generated net savings of $47 million in 2016, the Menlo Park, Calif.-based non-profit found in an independent analysis of publicly available ACO data and previously unpublished numbers from the Centers for […]

Democrats Ask CMS to Halt Skilled Nursing Regulatory Rollback

A group of 12 Democratic U.S. senators slammed the Centers for Medicare & Medicaid Services in a letter sent last week, claiming that its leadership’s decision to ease regulatory restrictions on nursing homes has put seniors in danger. “We write with deep concern over a string of actions by the Centers for Medicare & Medicaid […]

Michigan Considers Moving Long-Term Medicaid to Managed Care

Long-term care (LTC) groups in Michigan expressed alarm at the possibility of the state moving its $2.8 billion Medicaid nursing home and LTC services programs to managed care, according to a report in Crain’s Detroit Business. Under Section 1857 of the 2017-2018 state budget, the Michigan Department of Health and Human Services (MDHHS) must “explore the implementation […]

Spending on Nursing Care to Increase Steadily Through 2026

Annual expenditures on skilled nursing care will increase by 3.9% this year and keep rising through 2026, according to a new study from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. This rise in nursing home spending tracks with overall gains in outlays for health care services: Between 2017 and 2026, […]