‘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 […]

In Positive Move for Nursing Homes, CMS’ Prior Auth Rule Cracks Down Further on Medicare Advantage Plans

Piece by piece, nursing home operators are seeing stricter government oversight of Medicare Advantage (MA) plans, a welcome relief given that partnerships with such managed care plans have become a huge source of administrative burden for providers in the sector, especially as workforce shortages persist. Most recently, the Centers for Medicare & Medicaid Services (CMS) […]

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 […]

When Disparities and Differences in Resources Abound, Medicaid Acts as Stopgap

The need for Medicaid as stopgap coverage for long-term care is more apparent when looking at differences in race, gender and ethnicity, and rural versus urban status of the residents. This is according to an analysis conducted by ATI Advisory, which identified the impact of disparities and differences in resources – finances, insurance and social […]

Insights on Exposing, Resolving Chronic Underfunding of Nursing Homes

As nursing homes grapple with a tough economic and labor environment – which has forced closures and created access issues – patient and nursing home advocates underscored the emotional toll of care, calling upon the federal and state governments to do more to address new and emerging generational challenges to care. Anne Tumlinson, founder of […]

While More is Needed, Operators are ‘Generally Pleased’ With 4% Increase in SNF Final Rule

Nursing home operators had a mixed reaction to the Centers for Medicare & Medicaid Services (CMS) final payment rule for 2024. While some operators said that they were generally appreciative of the 4% increase in Medicare reimbursement, they are also calling for more help and understanding from federal agencies in tackling the workforce crisis – […]

Skilled Nursing Vs. Home Health: Referral Trends Shift Due to Acuity, Staffing Shortages, Regulation

After years in which Medicare policy and Covid-19 drove more hospital referrals to home health, skilled nursing facilities recently have seen referrals surge, thanks to a variety of factors. Referral trends through January 2023 showed a jump in patients sent to the nursing home while at the same time rejection rates for home health agency […]

Congress, States, CMS Urged to Ensure Nursing Facility Medicaid Rates Cover Care Costs

A Congressional advisory body on Wednesday put forth recommendations for closer assessment of nursing facility Medicaid payments, including whether they are sufficient to cover costs of care. The proposals could allow for a finer tuning of Medicaid rates and therefore could benefit the sector, as long as they do not put greater administrative costs and […]

CMS Data Shows SNFs a ‘Good Landing Spot’ For Less Acute Patients, Emboldens Calls for Ending 3-Day Stay Rule

As nursing home advocates continue to push for ending the 3-day hospital stay requirement, a recently released federal agency report on the use of these waivers by accountable care organizations (ACOs) showcases some of the benefits that they have brought to patients and providers. Use of waivers by ACOs for a 3-day stay did not […]

Skilled Nursing Operators Protest ‘Insane Amount’ of Administration Needed as Medicare Advantage Expands

As the federal government pushes to get more beneficiaries on managed care, nursing home providers say the administrative burden associated with such clients is “extraordinary.” That’s according to Kim Majick, chief development officer at Carespring Health Care Management. A heavier administrative lift is set against a backdrop of dire staffing shortages, along with staffing minimum […]

CMS Proposal Marks Shift After Years of Skilled Nursing Frustration with Medicare Advantage Diversions

The Centers for Medicare & Medicaid Services (CMS) has decided to take action on transitions in care – specifically Medicare Advantage (MA) plans diverting care to home health instead of skilled nursing – after years of skilled nursing industry and consumer feedback. CMS last month took steps to address the trend with a proposed rule […]

Why HUD Financing Has Potential to Propel the Nursing Home Industry Forward

Loans and other types of financing through the Department of Housing and Urban Development (HUD) may be key to incentivizing operators to seek innovation, such as scaling the small home model in a meaningful way – but the program isn’t quite at that point yet. The National Academy of Sciences, Engineering, and Medicine (NASEM) report […]

Medicare Advantage’s Steady Growth Has Nursing Home Operators Moving in ‘Radically Different Directions’

While so many nursing home trends have been altered by the pandemic, one has interestingly stayed in line with pre-pandemic statistics: Medicare Advantage’s (MA) growth trajectory. MA is still expected to cover 52.9% of all Medicare beneficiaries by 2031, according to Fred Bentley, managing director at ATI Advisory. Bentley spoke about Medicare’s evolution and its […]

Why Nursing Home Operators Shouldn’t Fear SNF-at-Home — At Least For Now

Skilled nursing operators shouldn’t be scared of losing market share to the shift to home trend, including SNF-at-home – at least not in the near-term. Instead, operators need to look at shifts to home-based care as an opportunity to diversify business lines in the future, as patient preference, Medicare Advantage (MA) plans and technology advancements […]

Federal Bill Seeks to Bring ‘Long-Overdue’ Transparency to Nursing Home Ownership, Finances

As the Biden administration continues to set its sights on nursing home ownership transparency, most recently through the unveiling of a new database, two members of Congress are trying to take it one step further. U.S. Rep. Jan Schakowsky of Illinois and Rep. Mark Takano of California last week introduced the Linking Investors and Nursing […]

The Math Doesn’t Work: Nursing Home Staffing Woes Unsolvable Without Immigration Action

As nursing home operators scramble to recruit direct care workers during a historic staffing shortage, many in the sector believe there is one obvious solution that has yet to gain meaningful traction, in part due to legislative gridlock: immigration. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has honed in on minimum staffing ratios, […]