‘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 […]

Top Trends That Will Shape the Skilled Nursing Sector in 2024

Margins squeezed by interest rates and inflation, staffing shortages amid a draconian staffing mandate proposal, an invasion of Medicare Advantage and mixed efforts at adapting to Minimum Data Set (MDS) changes are among a litany of the challenges facing the skilled nursing sector at the start of 2024. However, all is not doom and gloom […]

The Quotes That Defined 2023 in Skilled Nursing — and Hint at What’s Ahead

As the Covid-19 public health emergency officially ended in 2023, the nursing home sector continued to face lingering troubles across many facets of the business even if spread of disease – and death resulting from it – diminished as a concern. Chief among troubles that continued to plague nursing homes included workforce shortages and expansion […]

‘Tougher Every Day’: Nursing Home Operators, CCRCs Weigh in on Future of Skilled Nursing

Operating a skilled nursing facility today is considered a difficult business with regulations and reimbursement woes making the space “tougher every day.” As a result, some operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. This dire view of […]

Nursing Home and CCRC Spending Grew 5.6% to $191.3B in 2022 – After Dropping 7.8% in 2021

Nursing homes and continuing care retirement communities (CCRCs) made up $191.3 billion of national health expenditures in 2022, an increase from $181.1 billion in 2021, reaching levels close to the onset of the Covid-19 pandemic. Pre-pandemic, such expenditures sat between $162 billion and $174.1 billion between 2016 and 2019, according to a survey published by […]

Humana Is Latest To Face Lawsuit for AI-Based Denials of Medicare Advantage Claims in Nursing Homes

In facing a class-action lawsuit for its use of artificial intelligence in denying claims for services to residents in post-acute care, Humana (NYSE: HUM) joins the ranks of other health insurance behemoths such United Healthcare and Cigna. The complaint, filed late Tuesday, in a federal court in Kentucky, accuses Humana of using AI tools – […]

Nursing Homes’ Letter to CMS Calls Out Lack of Teeth – and Clarity – in Final Rule’s Medicare Advantage Reform

In order to keep Medicare Advantage plans in check for denial of services, provider organizations are pressuring federal authorities to do more, and asking them to closely monitor and aggressively enforce reforms for these plans as envisioned in a final rule that takes effect on Jan. 1. Companies managing MA plans have said they don’t […]

‘Operating Pressures Are Very Intense’: Ohio Living CEO on Skilled Nursing Strategy and Mega-Trends

Operational pressures continue to shape the landscape of the skilled nursing sector as many organizations with assets across the care continuum are divesting nursing homes in favor of other service lines. Responding to pressures from staffing and low reimbursements, Ohio Living decided to act “proactively” and downsize its skilling nursing segment while growing its services […]

Ignite CEO Focuses on Solutions, Growth Amid ‘Punitive, Vindictive’ Surveys, Managed Care Pressures

From managed care burdens and “punitive, vindictive surveys,” to threats posed by the potential federal staffing mandate and issues stemming from the “radically broken” Five Star rating system, Ignite Medical Resorts CEO Tim Fields is well aware of the many challenges facing skilled nursing providers. But as Ignite celebrates its fifth year as a company […]

Fighting the Market Not a Winning Strategy: United Church Homes CEO on the Future of Managed Care

United Church Homes (UCH) is continuing to make progress on a recently announced value-based care play with health plan provider CareSource, while responding to the ongoing market and regulatory pressures in the nursing home space. In June, UCH — with a portfolio of about 1,600 senior housing and care units, including 600 nursing home units […]