A lack of consistency in how the Centers for Medicare and Medicaid Services (CMS) reimburses programs serving special needs plan (SNP) populations is getting in the way of improving outcomes and reducing hospitalizations, according to providers, payers and consultants in the nursing home sector. Today’s institutional beneficiary is usually eligible for models with similar clinical […]
Special needs plans (SNPs) may be overhauled through streamlining or potentially by combining the various plans types. The Centers for Medicare and Medicaid Services (CMS) appears to be in an info-gathering stage when it comes to the future of SNPs, using requests for information (RFI), discussions with experts and other avenues to inform the agency’s […]
Mounting financial pressures among both Medicaid and Medicare payers, fragmented health care settings, and the growing use of value-based care as a cost-cutting measure are creating unique challenges and opportunities for nursing homes serving dual-eligible beneficiaries. Maintaining and evolving such plans will depend on how adept nursing homes are at providing strong data to demonstrate […]
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 […]
In dealing with Medicare Advantage pain points, skilled nursing providers are shifting their focus from resisting managed care to building stronger ties with health plans. This includes pruning unprofitable contracts, improving discharge planning, and some “soul searching” and concessions by each party as margins diminish for both health plans and providers. And while reimbursement pressures, […]
The rise of payviders — integrated payer-provider organizations with significant scale and market influence — is shifting the balance of power across healthcare, including skilled nursing. Payviders are expected to continue growing in certain markets, particularly in areas where Medicaid programs encourage or require provider-owned health plans. However, their success is not guaranteed, and many […]
The “alphabet soup” of new value-based care models from the Centers for Medicare & Medicaid Services (CMS) can be confusing and overwhelming for nursing home operators, but there are two models that should be on every provider’s menu: the Long-Term Enhanced ACO Design (LEAD) model and Transforming Episode Accountability Model (TEAM). Brian Fuller, managing director […]
The Centers for Medicare and Medicaid Services (CMS) is testing out a new preventative value-based care model with a possible path for nursing homes to get involved – if they have a robust dementia care program, innovative activities programs and dietary services, or a well-aligned clinical model with physicians and nurse practitioners. But, the model […]
The Centers for Medicare and Medicaid Services (CMS) recently opened applications for the Long-Term Enhanced ACO Design model (LEAD) and posted more guidance for prospective participants. The highly anticipated model replaces ACO REACH, which will be discontinued at the end of this year. While LEAD offers promising opportunities and improvements, it’s highly complex and demands […]
As the Centers for Medicare and Medicaid Services (CMS) hits reset on an important value-based care initiative popular with health care providers, including nursing homes, providers will need to make considerations this spring on whether to participate in the new model called LEAD – short for Long-term Enhanced ACO Design. Starting in 2027, the federal […]
Last year saw a sharp acceleration in new models of value-based care launched by the Centers for Medicare and Medicaid Services Innovation Center (CMS CMMI). This year will be pivotal as nursing home leaders decide which models to pursue, assess their impacts and identify key markets and partners. In all, an unprecedented seven new models […]
With the Transforming Episode Accountability Model (TEAM) launching in January, the level of readiness varies greatly among skilled nursing providers, as well as hospitals mandated to take part in the initiative. Some nursing home providers are in the position of educating hospitals about the program, giving these SNF operators a chance to stand out as […]
The Centers for Medicare & Medicaid Services (CMS) is seeking information related to dual-eligible enrollment in Medicare Advantage institutional special needs plans (I-SNPs). The agency is concerned that such plans have a high number of dual-eligible beneficiaries but are not designed specifically for this group, and is considering putting requirements in place that would align […]
The number of Medicare Advantage Institutional Special Needs Plans (I-SNPs) is down 5% for plan year 2026, but the number of I-SNPs led by a provider organization is up. This was one finding from an ATI Advisory analysis of Medicare Advantage (MA) plan offerings, which were the topic of an Oct. 1 webinar. Despite the […]
The One Big Beautiful Bill Act (OBBBA) has unintended consequences, with more tailwinds than headwinds, for nursing homes and other long-term care, placing greater burdens on states. According to ATI Advisory CEO Anne Tumlinson, who spoke at a webinar on Tuesday alongside other experts about the impact of OBBBA on long-term care, nursing homes are […]
Nursing home stakeholders remain cautiously optimistic regarding Medicare Advantage plan audits announced by the Centers for Medicare and Medicaid Services (CMS) last month, but many hope the agency will extend the same scrutiny to prior authorizations, AI usage and internal coverage criteria. Operators are unlikely to face reimbursement cuts as a result of the audits, […]
The Trump administration’s communications freeze, which has indefinitely blocked a majority of external communications by the Centers for Medicare & Medicaid Services (CMS), continues to cause turmoil for nursing home operators. This freeze, imposed last week, has disrupted the flow of key health care data, and extends to several federal agencies, including the Centers for […]
The Centers for Medicare and Medicaid Services (CMS) proposed a 4.33% increase in payments to Medicare Advantage plans for 2026, which could have an overall positive trickle-down effect on nursing homes. Expected to be finalized under President-elect Donald Trump’s administration, this slight payment boost comes after MA providers faced a modest rate reduction for 2025. […]
Despite the sector continuing to grapple with staffing shortages, rising operational costs, and regulatory uncertainty, emerging trends have skilled nursing leaders gearing up for a positive 2025, with fewer challenges and more opportunities on the horizon. As we look ahead, several key trends are expected to shape the sector from regulatory shifts to financial turbulence, […]
The nursing home industry has been on a wild ride this past year, with major regulation up in the air and a flip in the White House leaving operators unsure of whether they should applaud or brace for impact. Rhetoric surrounding the federal minimum staffing mandate has changed drastically throughout the year, with leaders condemning […]
