Congressional Leaders Push Back on Medicare Advantage Nursing Home Denials, Other MA Issues

As the Centers for Medicare & Medicaid Services (CMS) looks into more oversight for Medicare Advantage (MA), some progressive lawmakers are urging caution over Medicaid Advantage plans – long lamented among those in the nursing home industry – over deceptive advertising and high rates of denial for services. Members of Congress discussed pitfalls of Medicare […]

CMS Finalizes Physician Fee Schedule, with ACO Changes Relevant to Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) aims to further advance its overall value-based care strategy with the finalized 20224 Medicare Physician Fee Schedule (PFS) – adding ways for medically complex, high-cost beneficiaries like those in nursing homes to participate in Medicare Shared Savings Programs (MSSPs). Additionally, CMS therapy assistants can be more generally […]

CMS Clarifies MDS Mood Interview Changes in RAI Manual Updates

More guidance is available on how to conduct mood interview changes, with the Centers for Medicare & Medicaid Services (CMS) updating the Resident Assessment Instrument (RAI) manual to reflect key changes in the new Minimum Data Set (MDS). Notably, if a resident refuses or is unwilling to participate in the interview, assessors need to go […]

CMS Official: Nursing Home Staffing Mandate ‘Balanced and Achievable,’ Stakeholder Comments Valued

More than a month after the announcement of the federal minimum staffing proposal, an official with Centers for Medicare & Medicaid Services (CMS) reinforced the agency’s commitment to the rule and urged providers and other stakeholders to continue submitting comments on the matter by Nov. 6. Dr. Dora Hughes, acting CMS Chief Medical Officer and […]

‘Sirens Going Off’: Providers Warn of Mass Closures, Vast Nursing Home Deserts Due to Staffing Mandate

As nursing homes closures continue across the country, “nursing home deserts” are expanding, and the proposed federal staffing mandate is expected to exacerbate the problem. This is despite attempts to make the potential policy change easier for providers in rural markets, which are especially vulnerable to access issues. Operators in these areas point to the […]

Nursing Home Providers Exasperated with Vendor Issues, Error Codes in MDS Transition

Nursing home operators expressed frustration with Minimum Data Set (MDS) changes effective Oct. 1, with many concerned that they will be out of compliance with completion and submission requirements because of error codes. Errors are stemming from software vendors, and providers are unable to submit MDS data with proper coding information, nursing home operators said […]

Resident Voice Remains Main Focus of MDS Changes, As Nursing Home Providers Adjust and Educate

More than a week after updates to the Minimum Data Set (MDS) went into effect, each section change seems to be emphasizing focus on the resident’s voice, which along with substantial coding changes – four years in the making – will require time to incorporate, experts said. Kevin Cezat, director of clinical excellence for Therapy […]

‘A Brick Wall’: Overcoming Barriers to Census Growth at Nursing Homes From Managed Care Plans

As managed care plans continue to reshape the skilled nursing landscape, operators must navigate the complexities of managing patients under managed healthcare programs, including maintaining patient census levels, adapting to industry-specific policies, and addressing issues related to case managers’ involvement. As Medicare Advantage continues to penetrate the nursing home market, leaders have said that MA […]

AHCA: Staffing Proposal to Cost $6.8B Per Year, Create Access Issues for Nearly One Quarter of Nursing Home Residents

More than 280,000 residents, or nearly a quarter of all residents, could be impacted by the staffing mandate – if nursing home operators have no choice but to reduce their census in order to meet hourly requirements. The proposed federal mandate would require an estimated 102,154 additional full-time employees. That’s 80,077 certified nursing assistants (CNAs) […]

Biden’s Plans to Reduce Cost of Medicare Drugs To Send Ripple Effects Through Nursing Home Industry

Following the Biden Administration’s bid this week to reduce the price of certain drugs – many of which are commonly used in nursing homes – experts are cautioning that the changes may negatively impact the bottomline of organizations in the sector. As Medicare Part D price negotiations for these drugs come into focus this week, […]

Medicare Advantage Grabs Spotlight in CMS, Nursing Home Operator Discussion on MDS Requirements

It appears the Centers for Medicare & Medicaid Services (CMS) is paying particular attention to managed care payers as the agency re-examines data submission requirements for skilled nursing services through the Minimum Data Set (MDS). Nursing home operators were able to comment on various MDS-related questions posed by CMS officials during a Quality Reporting Program […]

CMS Releases Final RAI Manual, Item Sets as MDS Shift Looms

The skilled nursing industry is one step closer to Minimum Data Set (MDS) changes set to take effect on Oct. 1, with the Centers for Medicare & Medicaid Services (CMS) recently finalizing revisions to the Resident Assessment Instrument (RAI) manual. The final MDS 3.0 RAI User’s manual was made available online Thursday afternoon, following a […]