Policy analysts at the nonpartisan agency that advises Congress on Medicare policy are planning to investigate potential coding distortions, payment inaccuracies and whether financial incentives influence patient selection by nursing home providers as part of an assessment of payment accuracy in fee-for-service Medicare’s skilled nursing facility and home health payment systems. At its October meeting […]
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 […]
With greater scrutiny of case-mix growth and coding, nursing homes should be strengthening documentation. Operators should also prepare now for expanded MDS reporting requirements beginning in 2029, reimbursement experts said. To be sure, the Centers for Medicare and Medicaid Services (CMS) is not implementing a case-mix adjustment in the FY 2027 final rule, but the rule’s language makes clear […]
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 […]
CMS finalized its 2027 Skilled Nursing Facility Prospective Payment System (SNF PPS) rule, increasing rates by 2.4%, but nursing home leaders say the shortened clinical data reporting window will increase administrative burdens. The agency’s decision is based on the final SNF market basket of 3.3%, reduced by a 0.9% productivity adjustment for an estimated increase […]
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 […]
A specific type of collaboration between skilled nursing facilities (SNFs) and hospitals is gaining traction due to the financial benefits and quality improvements it can deliver. Known as the Post Acute Network (PAN) program and focused on patients discharged to SNFs, these initiatives are prompting nursing home operators to partner more closely with hospital systems […]
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 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 […]
The Centers for Medicare and Medicaid Services (CMS) is testing out a new preventative value-based care model with a possible path for nursing homes to get involved – if they have a robust dementia care program, innovative activities programs and dietary services, or a well-aligned clinical model with physicians and nurse practitioners. But, the model […]
The Centers for Medicare & Medicaid Services (CMS) is proposing a nationwide expansion of the Comprehensive Care for Joint Replacement (CJR) model, with the goal of driving more coordinated care for people receiving hip, ankle and knee replacements – including through skilled nursing facility services. This proposed expansion would build on the original CJR model, […]
As the Centers for Medicare and Medicaid Services (CMS) strives to improve and expand accountable care organization (ACO) models for the future, there’s a prime opportunity to better serve long-term care populations, including residents in nursing homes. For starters, the federal agency should consider simplifying the bureaucratic hurdles that keep more skilled nursing facilities (SNFs) […]
Medicare spends 14% more on Medicare Advantage (MA) enrollees than if they were to be enrolled in Medicare Fee-for-Service (FFS), equating to roughly $76 billion in additional spending estimated for 2026, according to the latest report from the Medicare Payment Advisory Commission (MedPAC). Medicare spent $537 billion on MA plans in 2025, not including prescription […]
The nursing home sector in 2026 will be defined by rapid change, leaders said, as payment constraints, workforce shortages and rising expectations from the public and government entities converge. All the while, operators brace for Medicaid uncertainty and Medicare Advantage growth. Shortened retroactive eligibility periods and potential state-level cuts to Medicaid programs may further contribute […]
The Centers for Medicare and Medicaid Services (CMS) has rolled out its first major change to the SNF Medicare Cost Report in 15 years, no longer accepting Resources Utilization Groups (RUGs)-based proxies for the Patient Driven Payment Model (PDPM). The efforts are aimed at better capturing managed care revenue and census, while refining the SNF […]
The GUIDE (Guiding an Improved Dementia Experience) model is proving difficult to implement for some providers who initially were excited about it, with one large nursing home provider already exiting the program. An official with the Centers for Medicare & Medicaid Services (CMS) said that lessons learned from early experiences in the program will inform […]
The Medicare Payment Advisory Commission (MedPAC) is once again beating the drum for reducing Medicare payment rates for skilled nursing facilities. Specifically, the commission’s draft recommendation calls for a 4% cut to the Medicare base payment rate to SNFs for fiscal year 2027. In the commission’s Dec. 5 public meeting, analysts presented on the payment […]
The Centers for Medicare and Medicaid Services (CMS) is set to indefinitely suspend its mandatory off-cycle skilled nursing facility provider enrollment validation, which had a deadline of Jan. 1, 2026. Associations including the American Health Care Association and National Centers for Assisted Living (AHCA/NCAL) have long asked for relief from the revalidation process, given the […]
Nearly one in six nursing home residents in the United States, who were admitted under Medicare or private pay, ended up enrolling in Medicaid during their stay after depleting their financial assets. This is according to a new study published in JAMA Network Open. The findings, based on a national sample of nearly 200,000 traditional […]
The Centers for Medicare and Medicaid Services (CMS) this week released the Minimum Data Set 3.0 quality measures user’s manual, with notable changes being far more sweeping than many in the sector expected. Two major updates involve the respecification of the long stay antipsychotic measure and a risk adjustor modification to the discharge function score […]
