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 […]
Category: Medicare
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 […]
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 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 […]
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 […]
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 […]
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 […]
Minimum Data Set (MDS) changes for 2024, along with updates to nursing home surveys were top of mind among representatives of the Centers for Medicare & Medicaid Services on Thursday, as the agency outlined its plans for next year in an Open Door Forum. CMS plans to release the MDS 1.19.1 in early 2024 with […]
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 – […]
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 […]
The costs of long-term care in every setting, including nursing homes, is considered out of reach for most seniors, averaging more than $100 per day nationwide. This is coupled with the fact that the majority of older adults with very low incomes will need such services and have the fewest resources to pay for them. […]
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 […]
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 […]
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 […]
Since Diversicare named Steve Nee as CEO in February 2023, the provider has eliminated agency staff across its portfolio of 44 nursing homes and now is reentering growth mode, with a focus on adding new service lines, particularly in behavioral health. Nee took the helm at the Brentwood, Tennessee-based company at a time of difficult […]
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 […]
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 […]
States continue to take action on addressing wage disparities for nursing home staff even as the industry undergoes massive shifts marked by economic, operational and regulatory changes. Skilled nursing facility staff, as well as other health care workers in California, will slowly see their hourly wage increase to $25 over the next decade under a […]
The latest proposed changes to the REACH accountable care organization (ACO) may make it even easier for skilled nursing facilities to be a part of an ACO program – and there may be implications for quality of care, industry leaders said. A broadened criteria and an attractive high needs population track is expected to be […]
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 […]
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