As Post-Acute Care Shifts Home, I-SNPs See Case for Expansion to Meet Growing Long-Term Share

The COVID-19 pandemic brought an unrelenting spotlight to clinical care in skilled nursing facilities — one that will shine in the form of government audits and investigations before the immediate crisis ends and long after it passes. But several operators had trained their sights on clinical care within their facilities before the start of the […]

Medicare Advantage Beneficiaries Log Almost 30% Fewer SNF Days Than Traditional Medicare

A new report comparing health outcomes for beneficiaries of Medicare Advantage (MA) and those on traditional fee-for-service Medicare put hard numbers to the differences in skilled nursing facility stays between the two groups. The findings show that MA beneficiaries spend far fewer days in SNFs than those covered by traditional Medicare. Specifically, SNF stays were […]

LTC-Led I-SNPs Continue to Launch for Now — But 2022 Will Be Year to Watch

When conferences were a staple of business development and not potential sources of contagion from COVID-19, skilled nursing providers would frequently pack the rooms featuring sessions on institutional special needs plans (I-SNPs). Under this model, SNFs can move into the Medicare Advantage world by offering their own insurance plans to beneficiaries who are living in […]

New Wave of ‘One-Sided’ Managed Care Contracts Could Lead to Payment Strains for Nursing Homes

Some aspects of the nursing home world do not change even during a global pandemic, and that includes the need to manage relationships with multiple payers. Several managed care organizations (MCOs) are now sending in their new contracts to skilled nursing providers as old agreements expire, Chad Bogar, the founder and CEO of the law […]

Provider-Led I-SNPs Grow 28% in 2021, Outpacing Traditional Medicare Advantage Insurers

Providers of nursing home care and other long-term services continued to expand their Medicare Advantage offerings into the 2021 plan year, as more operators look to gain financial control in a landscape where managed care maintains its steady march toward a Medicare majority. The number of provider-led Institutional Special Needs Plans (I-SNPs) increased from 76 […]

Medicare Advantage Growth Outpaced Traditional Medicare, 60% to 5%, Over Six Years

Medicare Advantage (MA) has seen dramatic enrollment growth over the past six years, significantly outpacing traditional Medicare, according to a report commissioned by the Better Medicare Alliance released October 15. The report, prepared by the actuarial firm Milliman, examined the growth in enrollment in MA and the similarities and differences between enrollees in that program […]

Medicare Advantage’s Strength During COVID-19 to Drive Expansion into New Markets, 50% Adoption by ’24

While the skilled nursing landscape continues to struggle both operationally and financially during the COVID-19 pandemic, those same negative forces have only served to strengthen private health plans — putting Medicare Advantage in an even better position to continue its growth. Cratering census and sharp declines in elective surgeries, while fiscally devastating for nursing homes, […]

Fresh Off Private Equity Pickup, Wound Care Provider AMT Seeks Skilled Nursing Expansion

A leading wound care provider sees expansion opportunity in both skilled nursing and the home despite the ongoing strains of COVID-19, with a recent private equity investment to back it up. American Medical Technologies in late August announced its acquisition by private equity firm One Equity Partners and investment management company The Silverfern Group, capping […]

CMS Orders Medicare Advantage Plans, MACs to Cover COVID-19 Tests Under New Nursing Home Guidance

The Centers for Medicare & Medicaid Services (CMS) on Friday instructed Medicare Advantage plans and Medicare Administrative Contractors (MACs) to begin covering all COVID-19 tests required for nursing home residents under new testing guidelines. The move came after the Centers for Disease Control & Prevention (CDC) updated its guidance around nursing home testing strategies last […]

How Saber’s I-SNP Partnership with Optum Gave the Operator a Head Start on COVID-19

In the era before COVID-19, specialty in-house Medicare Advantage plans had emerged as one of the hottest topics in long-term care — control the payer source, the thinking went, and an operator could eliminate the financial uncertainty and pressure that comes when working with managed care plans. But with a global pandemic running rampant through […]

Medicare Advantage Plans Provide Some COVID-19 Relief, But Big Questions Remain

The federal government has granted Medicare Advantage plans significant leeway when it comes to setting payment rates and other rules for skilled nursing facilities. In normal times, the crazy quilt of managed-care policies and exceptions creates headaches for operators and their billing teams. Amid the ongoing COVID-19 crisis, widespread variations in Medicare Advantage behavior add […]

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 […]