A lack of consistency in how the Centers for Medicare and Medicaid Services (CMS) reimburses programs serving special needs plan (SNP) populations is getting in the way of improving outcomes and reducing hospitalizations, according to providers, payers and consultants in the nursing home sector. Today’s institutional beneficiary is usually eligible for models with similar clinical […]
The pain points stemming from the continued expansion of Medicare Advantage (MA) have lingered for so long without a course correction that some nursing home organizations have altered their contracting practices with managed care groups. The headline per-diem rate is no longer the primary factor in deciding whether to accept or renew an MA contract […]
Special needs plans (SNPs) may be overhauled through streamlining or potentially by combining the various plans types. The Centers for Medicare and Medicaid Services (CMS) appears to be in an info-gathering stage when it comes to the future of SNPs, using requests for information (RFI), discussions with experts and other avenues to inform the agency’s […]
The nursing home sector is expected to get a lot more competitive in the years to come. As hospitality gets baked into every service line, AI use and strong interdisciplinary teams will be defining features of high-performing operators. But some existing headwinds will persist, including Medicare Advantage, Trilogy Health Services COO Todd Mehaffey told Skilled […]
Older adults with newer, more complex medical conditions were more likely to leave a Medicare Advantage plan for traditional Medicare, and this likelihood increased as medical complexity increased, according to a new study released Friday. The study published in the JAMA Health Forum builds on earlier research showing that people who develop serious illnesses, including cancer, were more likely to leave MA. In the latest exploration, the researchers […]
Medicare Advantage (MA) reduces the use of nursing home and other post-acute care services without measurable short-term effects on mortality or time spent at home, according to a study published Monday in Health Affairs that examined retirees in five states. The study explored the effects of MA enrollment on healthcare utilization by analyzing a natural experiment involving more than 220,000 retired […]
Mounting financial pressures among both Medicaid and Medicare payers, fragmented health care settings, and the growing use of value-based care as a cost-cutting measure are creating unique challenges and opportunities for nursing homes serving dual-eligible beneficiaries. Maintaining and evolving such plans will depend on how adept nursing homes are at providing strong data to demonstrate […]
Nursing homes are increasingly leveraging artificial intelligence (AI) to streamline referral processing and case management, with the ability to reduce hospital packets to concise summaries in under a minute and cutting referral review times in half. Payer-provider relationships are expected to evolve as a result, with tech-supported documentation and care planning inspiring payer trust in […]
In dealing with Medicare Advantage pain points, skilled nursing providers are shifting their focus from resisting managed care to building stronger ties with health plans. This includes pruning unprofitable contracts, improving discharge planning, and some “soul searching” and concessions by each party as margins diminish for both health plans and providers. And while reimbursement pressures, […]
It’s no secret that successful institutional special needs plan (I-SNP) partnerships depend on aligned incentives between the nursing home operator and insurer, trust between parties and organizational buy-in. However, achieving that cohesion is another matter. On the insurer’s side, co-designing benefits with providers and maintaining data transparency may be outliers when it comes to larger […]
The 2026 Medicare Trustees Report projects that the Medicare Part A trust fund will be depleted by the second quarter of 2033, as total spending on Medicare Parts A and B reached $481 billion in 2025, with skilled nursing facility services accounting for approximately $31 billion of that total. This is according to an analysis […]
The skilled nursing sector entered 2026 in a different environment than it faced a year ago, one rife with opportunities to expand its footprint and service lines, as well as redefine its business model. While operators continue to face reimbursement pressure, managed care complexity and workforce challenges, they have also been able to move away […]
Provider networks can be powerful tools for improving negotiating leverage with managed care organizations while also benefiting care coordination. But their effectiveness depends on local market conditions and the structure of the network, as well as a chosen reimbursement structure that makes sense for the market population. Meanwhile, nursing home operators in the middle of […]
Medicare Advantage plans denied about 12% of requests for admission to nursing homes and overturned almost all of those denials upon appeal, raising concerns that patients may have been initially denied critical medical care, according to a report posted Thursday by the Office of Inspector General (OIG). “The extremely high overturn rate indicates that some […]
Reimbursement inadequacy remains a widespread issue, with Medicare Advantage plans being the main culprit when it comes to financial and administrative pressure. In response, nursing home operators are limiting admissions from this payer type, while others have reduced services to pick up the slack, according to a survey conducted by Skilled Nursing News in anticipation […]
While declining relationships, payment and care delivery misalignment have come to define the nursing home sector’s overall experience with Medicare Advantage, successful strategies to manage managed care have come into focus. Among those strategies, providers have found that taking a firmer stance in contract negotiations can yield results. Walking away from contracts has been cited […]
Nearly 700 nursing home provider representatives will be urging federal lawmakers to take action on Medicare Advantage reform and other top policy priorities for the sector. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) kicks off its Congressional Briefing event on Monday. The most important endeavor for members is to share […]
American Senior Communities (ASC) is coming off a strong 2025 focused on quality care and is building on that success to weather industry challenges while executing on key initiatives, including the growth of a provider-led institutional special needs plan (I-SNP). ASC has 114 properties in Indiana, 94 of which are focused on skilled nursing. The […]
The Centers for Medicare & Medicaid Services (CMS) is proposing to expand the Skilled Nursing Facility Quality Reporting Program (SNF QRP) so that reporting requirements would apply to all payer types, not just Medicare residents. Extending this will create substantial administrative, staffing and financial burdens for nursing homes, leaders said. CMS’s proposal to require admission […]
The accountable care organization (ACO) model is shaping up to be the base that future value-based care models will be built on, with more than 50% of Medicare fee-for-service (FFS) beneficiaries being aligned with an ACO now. While there’s a lot of room for improvement in the ACO model, the Centers for Medicare and Medicaid […]
