Some Managed Care Plans Lift Restrictions on Skilled Nursing Coverage Amid COVID-19 — But Not All

Multiple managed care plans have made changes to their procedures for admissions to the skilled nursing setting amid the ongoing coronavirus pandemic, with several major companies suspending prior authorization requirements for admissions to a skilled nursing facility. The changes, however, are not uniform — and that’s if the managed care organization (MCO) chooses to make […]

‘Plow It Down’: Nursing Home Operators, CMS, Insurers Must Think Bigger to Fight COVID-19 Tide

Over the past few weeks, we’ve seen the federal government rapidly dismantle the dense scaffolding of rules and regulations that had been built over the course decades, all in the name of fighting the novel coronavirus. Ideas once unthinkable — doctors providing consultations over Skype without fear of violating HIPAA, a blanket freeze on the […]

Medicare Advantage Plans Attracting Lower-Income Seniors — While Saving Them $1,600 Per Year

Medicare Advantage plans have long been a thorn in skilled nursing facilities’ sides, with lower-per day rates and increased pressure to reduce lengths of stay than traditional fee-for-service Medicare. But a new report shines a light on why seniors are increasingly choosing the plans in the first place, reinforcing recent calls to embrace working with […]

I-SNPs vs. ACOs: Balancing the Skilled Nursing Risks, Rewards of Two Hot Payment Models

As the skilled nursing industry struggles to adapt to a new Medicare payment landscape, in-house Medicare Advantage plans have emerged as one of the hottest topics among leaders — while the space’s publicly traded behemoth has thrown its full support behind the separate accountable care organization (ACO) model. There may not be one set answer […]

Buoyed by Series A Funding, Skilled Nursing Telehealth Firm Tapestry Targets Managed Care, Home Health

Fresh off a successful Series A funding round, a telehealth company that built its platform around serving rural skilled nursing facilities sees growth ahead in urban markets — as well in serving other post-acute providers along the continuum. TapestryCare last week announced the completion of a funding round led by the New York City-based Sopris […]

Payment Outlook: 60% of MA Plans Cover Telehealth, 95% of Post-Acute Providers Subject to Alternate Models

The new fee-for-service Medicare model absorbed much of the oxygen around nursing home payment reform in 2019, but 2020 — as well as the years beyond — will bring a slew of alternate payment pressure to the post-acute sector. Over the next two years alone, 95% of post-acute operators will find themselves in new payment […]

AHCA’s Parkinson: PDPM is Running Above Budget-Neutral, But Clawbacks Aren’t Inevitable

Early analyses of the new Medicare payment model for nursing homes indicate that operators may be pulling in more money than the federal government intended — leading to widespread speculation that adjustments could be coming sometime in 2020. American Health Care Association (AHCA) president and CEO Mark Parkinson agrees with the idea that the Patient-Driven […]

CMS Taps Anthem Vet Smith for Top Innovation, Value-Based Care Posts

The federal government on Monday announced the appointment of Brad Smith, a health care and insurance industry veteran, as the next head of the Center for Medicare & Medicaid Innovation (CMMI). Smith, previously the chief operating officer at insurance giant Anthem’s diversified business group, will additionally serve as senior advisor for value-based transformation to Department […]

‘All the Stars Aligned’: Operators Boast 30% Readmission Reductions, Market Gains with I-SNPs

As skilled nursing facilities work to establish their position in an increasingly value-based health landscape, many are looking at the world of Medicare Advantage as more than a pressure point for billing. They see it as an opportunity to take control of the premium dollar, moving into the business of providing insurance for their patients. […]

Rapid Medicare Advantage Expansion into Home Health, Senior Living Could Accelerate Pressures on Skilled Nursing

When the Centers for Medicare & Medicaid Services (CMS) moved to allow Medicare Advantage plans to cover more options for care at home, skilled nursing providers could be forgiven for not paying much attention. It’s a move with more immediate impact to home care and home health companies, as well as senior living providers. Medicare […]

94% of Seniors Satisfied with Medicare Advantage — But Many Still Don’t Know About Managed Care

Medicare Advantage, a frequent source of headaches for skilled nursing operators, remains overwhelmingly popular among seniors, according to a new poll — and its growth has come even as many enrollees remain unaware of their options when they turn 65. About 94% of seniors with Medicare Advantage plans reported being “satisfied,” a poll commissioned by […]

Some States Skeptical of I-SNPs as Long-Term Solutions for Nursing Home Coverage

Special Medicare Advantage plans for long-term nursing home residents have emerged as a significant growth opportunity for operators in the space, but state governments around the country may not necessarily be on board. In fact, states may see Institutional Special Needs Plans (I-SNPs) as directly in opposition to their goal of shifting residents away from […]

Sharp Rise in Ancillary Medicare Advantage Benefits — from Adult Day to Home Care — Coming in 2020

Medicare Advantage plans are rapidly expanding the supplemental benefits recently approved by the federal government, with 116 plans offering more than one of these services for the 2020 contract year. Those supplemental benefits provide more options for care at home for beneficiaries — and could potentially represent paths away from the skilled nursing setting. In […]

I-SNP Case Studies Show Promise in Era Where Fee-for-Service Medicare Looks Unsustainable

Despite the challenges, skilled nursing facilities have succeeded at setting up their own specialty Medicare Advantage plans — and the strategy represents a key potential weapon amid the rise of alternative payment models. Institutional Special Needs Plans (I-SNPs) remain a small part of the overall Medicare Advantage landscape, according to a panel discussion at the […]

‘It’s Not That Easy’: What Skilled Nursing Operators Should Consider Before Launching — or Joining — an I-SNP

On paper, a skilled nursing facility starting its own specialty Medicare Advantage plan sounds like an easy decision: In an era of tight reimbursements, staffing pressures, and length-of-stay declines, why not control the payment source that so frequently vexes them? But according to René Lerer, the calculus for Institutional Special Needs Plans (I-SNPs) just isn’t […]

10 Long-Term Care, Senior Living Companies Develop 78-Facility I-SNP

A non-profit health plan and a care coordination company in the Minneapolis area teamed up with almost 80 senior care locations to offer a Medicare Advantage plan specifically tailored for adults in long-term care, assisted living, and memory care settings. The institutional special needs plan (I-SNP), Medica Advantage Solution PartnerCare, will be available for January […]

Trump Signs Order Seeking Parity Between Fee-For-Service, Medicare Advantage Rates

President Trump on Thursday signed an executive order asking top federal officials to explore a wide variety of Medicare Advantage expansion efforts, including a call to more closely align the rates paid by MA plans and traditional fee-for-service Medicare. Among the order’s provisions is a request for Department of Health and Human Services (HHS) secretary […]