Nursing homes would be wise to establish protocols – and comment on a certain proposed rule – to safeguard themselves from complications stemming from fraud, waste and abuse initiatives underway as part of a broader focus on Medicare and Medicaid program integrity. That’s because the Trump administration has made this a government-wide priority, and one of the first glimpses […]
CMS finalized its 2027 Skilled Nursing Facility Prospective Payment System (SNF PPS) rule, increasing rates by 2.4%, but nursing home leaders say the shortened clinical data reporting window will increase administrative burdens. The agency’s decision is based on the final SNF market basket of 3.3%, reduced by a 0.9% productivity adjustment for an estimated increase […]
Nursing home operators may be in for a rude awakening Wednesday, when an update to the 5-Star Quality Rating System, requiring more points for ratings, goes into effect. That’s because the Centers for Medicare and Medicaid Services (CMS) is increasing quality measure thresholds by one-half of the average improvement in QM scores. While thresholds to […]
The U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) on Tuesday deferred more than $1 billion in federal Medicaid payments to California and Minnesota. The agencies plan to expand this deferment tool in the future. That’s approximately $867.5 million in deferred federal payments to California, and $199 million […]
As the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model winds down this year, federal findings offer insights into the future of accountable care for medically complex beneficiaries – many of whom reside in a nursing home. ACO REACH reduced gross Medicare spending by $706 million overall, the American Health Care […]
The Centers for Medicare and Medicaid Services (CMS) is launching a new risk-based survey process to “modernize” nursing home oversight by focusing inspection resources where they are most needed while recognizing high-performing facilities, the agency said Thursday. The agency noted that the changes to the survey process are driven by limited funding for nursing home […]
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule this week jam-packed with reforms to the Merit-Based Incentive Payment System (MIPS), ACO participation and the Physician Fee Schedule (PFS). Overall, CMS proposed a 1.19% decrease in the PFS conversion factor for 2027, but providers unable to participate in PFS incentive programs, including […]
After its bankruptcy sale, Genesis Healthcare executives honed in on the evolution of its management team, investing in administrators and directors of nursing differently, while doubling down on its locally structured “pod model,” which has been in development for the past two years. Jake Komin, chief performance officer for Genesis views the bankruptcy as a […]
Following the Supreme Court ruling allowing the Trump administration to end Temporary Protected Status (TPS) for Haitians, Syrians and possibly more than 1.3 million immigrants from multiple countries, nursing home leaders say major access issues are on the horizon. Immigrants who have legally lived and worked in the country for years, including those in the […]
Medicare Advantage plans denied about 12% of requests for admission to nursing homes and overturned almost all of those denials upon appeal, raising concerns that patients may have been initially denied critical medical care, according to a report posted Thursday by the Office of Inspector General (OIG). “The extremely high overturn rate indicates that some […]
Nearly 700 nursing home provider representatives will be urging federal lawmakers to take action on Medicare Advantage reform and other top policy priorities for the sector. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) kicks off its Congressional Briefing event on Monday. The most important endeavor for members is to share […]
The American Nurses Association and a group of other organizations have jointly filed suit against the Department of Education over its final rule excluding nursing from the “professional degree” designation. The American Nurses Association (ANA) and nine other nursing organizations filed the suit in response to a policy, starting July 1, excludes post-baccalaureate nursing degree […]
Senate Democrats are seeking to improve access to affordable long-term care by using incentives to address workforce shortages, increasing nursing home quality and expanding home care services. The initiative was outlined in a letter signed by Senate Finance Committee Ranking Member Ron Wyden and 16 other Senate Democrats. The budget reconciliation signed by President Donald […]
Nursing home providers are urging the Centers for Medicare and Medicaid Services (CMS) to proceed carefully with its anti-fraud initiative for health care, warning that overly broad enforcement actions could increase administrative burden and disrupt patient care. The federal agency, which introduced its Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative in late February, asked […]
The Centers for Medicare and Medicaid Services (CMS) is adding electronic prior authorization to the Health Tech Ecosystem, bringing electronic health record (EHR) vendors, health systems, hospitals, physician practices and digital health developers to the table with payers. The idea is to make a unified coalition aligned around making electronic prior authorization work end-to-end on […]
Lawmakers introduced a bill this week to address growing concerns within Medicare Advantage. It aims to strengthen oversight and patient protections, responding to delays from prior authorization, inconsistent coverage decisions and administrative barriers. The Medicare Advantage Improvement Act of 2026 includes provisions to prevent delays and denials of care, increase transparency in prior authorization, penalize […]
The Centers for Medicare and Medicaid Services (CMS) on Thursday issued its Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, increasing Medicare rates by 2.4%. The federal agency is also proposing to remove two measures from the SNF Quality Reporting Program (QRP). The 2.4% increase is based on the proposed SNF market basket […]
As the Centers for Medicare and Medicaid Services (CMS) strives to improve and expand accountable care organization (ACO) models for the future, there’s a prime opportunity to better serve long-term care populations, including residents in nursing homes. For starters, the federal agency should consider simplifying the bureaucratic hurdles that keep more skilled nursing facilities (SNFs) […]
The Centers for Medicare and Medicaid Services (CMS) is “actively” reviewing federal rules on antipsychotic use for residents in nursing homes, aiming to support clinically appropriate use while discouraging misuse. The review follows a January update designed to improve reporting accuracy, and industry experts say the policy could also be simplified. “CMS is actively reviewing […]
Higher Medicaid payment rates are associated with a greater likelihood of receiving 4- or 5-star Care Compare ratings, according to a new study published in the Journal of the American Medical Directors Association (JAMDA). In the cross-sectional study published last week, researchers used 2019 data from 9,473 freestanding nursing homes across 44 states to analyze […]
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