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 […]
With the Transforming Episode Accountability Model (TEAM) launching in January, the level of readiness varies greatly among skilled nursing providers, as well as hospitals mandated to take part in the initiative. Some nursing home providers are in the position of educating hospitals about the program, giving these SNF operators a chance to stand out as […]
Achieving financial stability and growth in the current reimbursement environment is no small task for nursing home providers. Three particular challenges relate to value-based purchasing (VBP) program changes, effects of the One Big Beautiful Bill Act (OBBBA) and the continued rise of Medicare Advantage, leaders with Ignite Medical Resorts and ArchCare said during a recent […]
The Centers for Medicare & Medicaid Services (CMS) is seeking information related to dual-eligible enrollment in Medicare Advantage institutional special needs plans (I-SNPs). The agency is concerned that such plans have a high number of dual-eligible beneficiaries but are not designed specifically for this group, and is considering putting requirements in place that would align […]
Skilled nursing leaders are renewing calls to eliminate the three-day stay rule in light of a policy change that the Centers for Medicare & Medicaid Services (CMS) finalized last week. Specifically, CMS is moving ahead with plans to phase out the inpatient-only (IPO) list, which details the procedures that Medicare covers only if the beneficiary […]
The former CEO of a skilled nursing facility provider has been sentenced to 90 months in prison and ordered to pay $146 million in restitution and $8.4 million in forfeiture, in a case involving fraud and conspiracy. The SNF company itself – KBWB Operations LLC, which did business as Atrium Health and Senior Living (KBWB-Atrium) […]
Pinnacle Multicare Nursing and Rehabilitation Center received overpayments exceeding $31.2 million, as a result of noncompliance with Medicare requirements under the Payment Driven Payment Model (PDPM), a federal watchdog group estimated in a report posted Tuesday. However, Pinnacle is countering that coding guidelines were misapplied and the audit failed to consider waivers in place during […]
The phenomenon of patients trapped in a “rehabbed to death” cycle is all too prevalent, and it could be disrupted by better access to palliative care and earlier admission into hospice, skilled nursing leaders believe. Their observations come following a study published in the Journal of the American Geriatrics Society. The study’s authors proposed that […]
Recently released research affirmed what skilled nursing operators know all too well: Medicare Advantage requirements are creating impediments to patients’ timely care transitions. That’s according to SNF provider leaders who spoke with Skilled Nursing News (SNN) in the wake of a JAMA study outlining how Medicare Advantage patients averaged longer pre-SNF hospital stays than traditional […]
Demographic pressure, policy reform and digital advances mark 2025 as a defining moment for the skilled nursing sector, and winners will be defined by quality, data-driven decision making, and alignment with value-based care models, according to CliftonLarsonAllen’s (CLA) latest analysis. Operators would do well to realign with reimbursement models, understanding that quality is currency, and […]
While the 2026 Medicare Physician Fee Schedule (PFS) at first was expected to provide financial relief for nursing homes and therapy providers, the finalized rule ended up being more of a mixed bag. Adjustments made to the PFS will result in lower payments for some physicians, especially those treating nursing homes patients, and an “efficiency […]
Fragmented Medicaid coverage coupled with the lack of a dental benefit under traditional Medicare leads to poor oral health outcomes for older adults in nursing homes. Staffing shortages and rural access issues compound the problem. This is the conclusion of an issue brief from Justice in Aging, a national organization focused on helping seniors from […]
Family and patient mistrust of nursing home providers can create a barrier to care. A multidisciplinary team is needed to craft care plans and rebuild trust after something goes wrong. That’s according to a case study presented by Cleveland Clinic geriatrician Luke Dogyun Kim, M.D., at the 2025 Annual Meeting of the American Geriatrics Society. […]
Skilled nursing providers are adapting to a new, post-pandemic landscape for working with acute-care partners and participating in value-based care models like accountable care organizations (ACOs). However, it remains essential for SNF providers to get a seat at the table early in the process and play a role in building partnership models. These are some […]
The federal government shutdown that began on Oct. 1 is likely to cause minimal disruption to nursing home operations, but surveyors will be adhering to contingency plans and providers are concerned about reduced telehealth access. “Seniors, their loved ones, and their caregivers can rest easy that their long term and postacute care will be minimally […]
The Centers for Medicare & Medicaid Services (CMS) is making several updates to the Civil Monetary Penalty Reinvestment Program (CMPRP), including changes to how nursing homes apply for funds and the types of projects that these funds are available to support. Among the changes, CMS is accepting applications for workforce enhancement projects that will “complement” […]
In the aftermath of the One Big Beautiful Bill Act (OBBBA), hospital funding cuts could disrupt care coordination, delay discharges, and heighten competition with nursing homes for Medicaid resources. But nursing home providers also could have new opportunities to strengthen their relationships with hospitals and achieve some long-sought policy wins. One major shift that nursing […]
By Kristin Carroll Skilled nursing facilities can leverage the Patient Driven Payment Model (PDPM) to provide more palliative care to people near the end of life, helping to drive value-based care goals while improving the patient experience. However, much more needs to be done on the policy level to disrupt the current status quo, in […]
The Centers for Medicare & Medicaid Services (CMS) is taking steps to rescind the controversial federal staffing mandate for nursing homes. The White House Office of Management and Budget (OMB) is reviewing an Interim Final Rule from CMS with the title “Repeal of Minimum Staffing Standards for Long-Term Care Facilities,” according to an online posting […]
The Trump administration’s approach to regulation is creating long-sought opportunities for nursing home providers to have more say in shaping policies, but providers must do a better job of promoting the areas in which they excel. Steve LaForte, CFO and principal at Cascadia Healthcare, describes the new administration’s approach as “rational regulation” – a way […]
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