‘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 […]

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 […]

Inside the CMS Policies That Could Improve Care, Payments for Dual-Eligible Nursing Home Residents

Given that a vast majority of long-stay nursing home residents are dual eligible for Medicare and Medicaid, residents and facilities alike can reap financial benefits while improving quality of care and reducing administrative burdens if federal and state policies better enabled a value-based care model that integrated the experiences of dual eligibles. This is the […]

OIG Plans To Audit Nursing Home Survey Practices This Year – With Results Expected in 2025

The Office of the Inspector General (OIG) will be auditing nursing home survey practices this year with results expected in 2025, following concerns that third-party contractors may not have sufficient oversight in the space. OIG suggested closer scrutiny of the Centers for Medicare & Medicaid Services (CMS) regulatory practices when it came to surveys, given […]

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 […]

Nursing Home Operators Feel There’s a Lot to Learn From Hospice Surveys Despite Regulatory Differences

Many nursing home operators that also have hospice operations can’t help but notice that the survey process on the hospice end is generally a more positive experience than in the nursing home world. And some say the collaborative nature – between facilities and the federal government – of hospice surveys can and should be replicated […]

CMS Focuses on Resident Mood Interviews in Newly-Issued Nursing Home MDS Draft

The Centers for Medicare & Medicaid Services (CMS) on Friday issued its draft Minimum Data Set (MDS) — earlier than the federal agency’s typical timeline and with less sweeping changes compared to past years. Changes, effective Oct. 1, include an update to the list of state RAI coordinators, MDS automation coordinators, CMS locations and contacts, […]

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 […]

KFF: Nursing Home Deficiencies Jumped Almost 10% Since 2015 and Staffing Levels Are To Blame

Deficiencies in nursing homes, both on average and those deemed more serious, have increased over time – partly as a result of decreasing staffing levels. Between 2015 and 2023, facilities with serious deficiencies, or violations of federal regulations, increased from 17% to 26%, according to a data note published on Friday by KFF. The average […]

Nursing Home Associations: HHS Needs To Do Its Part to Boost Vaccine Uptake as Latest CDC Data Shows Lags

The Department of Health and Human Services (HHS) and its Secretary, Xavier Becerra, need to “do its part” to increase Covid vaccination rates among nursing home residents, starting with easing logistical issues that continue to be barriers to uptake. That’s according to LeadingAge President and CEO Katie Smith Sloan, who also cited the benefits of […]

Comprehensive Healthcare Legal Saga Culminates in Acquittal of Individuals, Guilty Verdict for Corporate Defendants

Pennsylvania operator Comprehensive Healthcare Management Services was found guilty in a sprawling health care fraud case, following a five-week federal trial in Pennsylvania, involving two of its facilities. Brighton Rehabilitation and Wellness Center and Lebanon Rehabilitation and Wellness Center were found guilty of making false statements in connection with the payment of health care benefits […]

‘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 […]

Repositioning Nursing Homes For Acuity, More Closures, Less Deal Making Expected in 2024

As the skilled nursing industry heads toward a new year with continued labor shortages and reimbursement gaps, service repositioning and closures among operators are expected trends for the space. And although there are signs of positivity in the form of increased Medicaid reimbursement in some states, extensive rural closures are creating “nursing home deserts” and […]

US Supreme Court Denies Medicare Fraudster Philip Esformes Appeal Hearing To Throw Out Conviction, Penalties

Nursing home operator Philip Esformes – convicted of one of the biggest Medicare frauds in history and whose 20-year sentence was commuted by President Donald Trump – was denied an appeal hearing by the U.S. Supreme Court on Monday to throw out his conviction altogether. While Trump commuted Esformes’ prison sentence in December 2020, he […]

MedPAC Advises Cutting Skilled Nursing Medicare Payment Rate by 3%

The Medicare Payment Advisory Commission (MedPAC) is recommending that for fiscal year 2025, Congress should reduce the 2024 Medicare-based payment rates for skilled nursing facilities (SNFs) by 3%, citing strong margin projections, occupancy growth and access to capital for the sector. “We project the SNF margins in 2024 to remain high even with the downward […]

Dealmaking In Nursing Homes: Bubble Will Burst As States Aim for Budget Neutrality During Medicaid Recalibration

In adjusting to new case-mix systems under the Patient Driven Payment Model (PDPM), the changes to reimbursement rates might be more widespread and large-scale than anticipated, posing financing threats to the nursing home sector because lenders are basing loans on rate projections that are expected to be scaled back. The goal of budget neutrality – […]

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 […]