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 […]
Category: 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 […]
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 […]
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 […]
Ahead of the upcoming Minimum Data Set (MDS) changes on Oct. 1, the preparation of clinicians is mixed and may have a lot to do with company size and regional market, along with resources to stay apprised of reimbursement updates. Many clinicians feel stressed and overwhelmed by the adjustments, with some playing catchup to the […]
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) […]
Fewer than one in five facilities would currently meet the required number of hours for RNs and CNAs as set forth in the federal minimum staffing proposal, with more than 80% of the facilities nationwide needing to hire more nursing staff. This is according to an analysis published by KFF on Monday. Interestingly, almost half […]
A big question that operators must ask themselves when considering involvement in an institutional special needs plan, or I-SNP, is ultimately wrapped up in how much money is being made on the Medicare Part B therapy side, some say. It might not make financial sense to sign up for an I-SNP if a SNF operator […]
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, […]
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 […]
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 […]
Some nursing homes are seeing “significantly more” audits tied to managed care and dual plan Medicaid claims in certain states – and potentially could see the same from Medicare too. This is all on top of an improper payment probe the Centers for Medicare & Medicaid Services (CMS) is conducting for Patient-Driven Payment Model (PDPM) […]
Audits have been trickling in for the 5-claim improper payment probe and educate review led by the Centers for Medicare & Medicaid Services (CMS), which had announced its plans to implement the review for all SNF operators in the country in June. A webinar hosted by Therapy Management Corporation (TMC) on Tuesday delved into how […]
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