Nursing Home, CCRC Spending To Reach $337B by 2032, as Insurance Enrollment Reaches New Heights

Expenditures for Nursing facilities and continuing care retirement communities (CCRCs) is expected to reach $237.6 billion in 2026, and $337.4 billion by 2032, according to data released Wednesday. Nursing homes and CCRCs have been increasing steadily since 2021, states a report prepared by the Office of the Actuary (OACT) at the Centers for Medicare & […]

‘Custodial Care Rates’: Avamere, FPACP, LeadingAge Execs on Mitigating Headaches Tied to Medicare Advantage Plans

Managed care’s growth across all health care settings, including nursing homes, has pushed reimbursement rates lower, and operators are implementing strategies to counter the situation.  For starters, operators expressed the need to be well equipped for negotiating better rates with managed care organizations (MAOs). And, coming armed with cost of care data to the negotiating […]

LTC100 Panelists Weigh in on CMS Staffing Rule’s ‘Bloodbath’, Growth Strategies, and Risk-Based Model Reimbursement

If there’s no additional funding for the minimum staffing rule, well over 5% of existing facilities will close, depending on how successfully operators can pivot to meet the standard. The rates of closure may even reach 10% to 15%, depending on the market, cautioned sector leaders attending the LTC100 conference this week. Steve Nee, CEO […]

Medicare Advantage Growth Could Normalize, but Nursing Home Leaders Call for Rate Floor and Other Changes

While Medicare Advantage (MA) has grown steadily in the last several years, leaders in the nursing home sector speculate whether increased federal regulation – and perhaps even more importantly, changes in the consumer experience – will slow its growth. This would come as a welcome development to many nursing home leaders, who have been struggling […]

‘Further Squeezed’: Medicare Advantage Reimbursement Cuts Could Dig into Nursing Home Payments

Medicare Advantage plans might lower their payments to nursing homes in 2025, to absorb the federal government’s benchmark rate cut to insurers. Nursing home advocacy groups are worried that this move by the Centers for Medicare & Medicaid Services (CMS) to cut Medicare Advantage rates may be passed on to nursing home providers. The Medicare […]

‘Borderline Useless’ CMS Data Needs an Overhaul, Starting with the Addition of Medicare Advantage to Cost Reports

Conspicuously absent data on Medicare Advantage (MA), along with stagnated data collection overall by government agencies, should give nursing home operators cause for concern especially as this trend has influenced company advocacy and negotiating power when it comes to insurance plans. Having this data and understanding how it’s calculated can help operators “speak the same […]

Aldersbridge CEO: Tone Deaf Policy, MA Giants Have Backed Nursing Homes into a Corner

As inadequate funding squeezes nursing homes dry, with Medicare Advantage reimbursing lower than traditional Medicare, and Medicaid funding decades behind on meeting cost of care, facilities are shifting operations to optimize reimbursement. But even that may not be enough. Richard Gamache, CEO of Aldersbridge Communities in Rhode Island, has had to make such operating decisions […]

‘Money Out of Our Pockets’: $274.9M in Nursing Home Revenue Lost For Every Percentage MA Plans Grow

As Medicare Advantage continues to grow in the skilled nursing space, beneficiaries utilizing traditional Fee-For-Service Medicare have declined, and in turn reimbursement has dropped at an alarming rate. For every two beneficiaries that opted for MA, one FFS individual left the program in 2023, the first year the number of FFS beneficiaries declined in every […]

More Scrutiny on Medicare Advantage Data Collection: MedPAC Report Dives into Encounter Data

More government scrutiny of Medicare Advantage (MA) plans and data sharing with nursing homes could reduce claims denials and burdens associated with such plans, sector leaders have long argued. And now a report released Thursday by a Congressional advisory body backs that view in shedding light on how enrollees are captured in data. The Medicare […]

‘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 Good Samaritan Society Is Investing $200M in New CCRC After Nursing Home Pullback

Sanford Health announced plans Tuesday to break ground on a $200 million project for a continuing care retirement community (CCRC) in South Dakota through its subsidiary, the Evangelical Lutheran Good Samaritan Society. The Good Samaritan Society executives told Skilled Nursing News that the funding for the project is an outcome of a strategy to expand […]

CMS: Medicare Advantage Plans Can Use AI Tools To ‘Assist’ but Not Terminate Post-Acute Care Stays

The Centers for Medicare & Medicaid Services (CMS) is placing limits on the use of artificial intelligence (AI) tools in denials of claims related to Medicare Advantage plans, and adding more guidance to health care providers on post-acute care admissions. The agency issued an FAQ Tuesday to address concerns related to coverage criteria and utilization […]

In Positive Move for Nursing Homes, CMS’ Prior Auth Rule Cracks Down Further on Medicare Advantage Plans

Piece by piece, nursing home operators are seeing stricter government oversight of Medicare Advantage (MA) plans, a welcome relief given that partnerships with such managed care plans have become a huge source of administrative burden for providers in the sector, especially as workforce shortages persist. Most recently, the Centers for Medicare & Medicaid Services (CMS) […]

As Medicare Advantage Policies Compound, More Regulatory Activity Expected in Coming Months for Nursing Homes

Nursing home operators can expect to see a lot more regulatory activity in the next few months, with rules and regulations being finalized prior to a potential presidential administration change, with that administration taking office in 2025. A slew of proposed and finalized rules were issued by the Centers for Medicare and Medicaid Services (CMS) […]

Big Players in Medicare Advantage, Cigna and HCSC, Involved in Planned $3.3B Deal 

As Medicare Advantage becomes an increasingly important – and controversial – payer for skilled nursing services, operators should note a major shift has occurred in the insurance landscape. Cigna Group (NYSE: CI) agreed Wednesday to sell its Medicare businesses and CareAllies to Health Care Service Corporation (HCSC). HCSC said it intends to acquire the Cigna […]

Why the Proposed Medicare Advantage Plan and Part D Rule Is Favorable for the Nursing Home Space

The federal government’s Medicare Advantage and Part D proposed rule offers nursing home operators several favorable updates, including those related to the appeals process for terminating SNF services as well as alleviating burdens posed by choice and multiple plans for dual eligible residents. The Centers for Medicare & Medicaid Services (CMS) has been working on […]

As a ‘Better Advisor’ to Congress, MedPAC Mulls CMS Staffing Mandate Effects But Proposes 3% Medicare Cut

The majority of MedPAC board members voted Thursday to recommend reducing Medicare-based payment rates for skilled nursing spending by 3% for 2025, despite voicing concerns about the federal minimum staffing proposed rule. MedPAC, which stands for the Medicare Payment Advisory Commission, is made up of health care professionals who make recommendations to Congress in terms […]