CMS Again Moves to Expand Telehealth Coverage Under Medicare Advantage

The federal government on Friday unveiled a series of new test benefits that certain Medicare Advantage plans can offer, including expanded telehealth coverage — marking yet another push toward remote health care benefits. The Centers for Medicare & Medicaid Services (CMS) will implement the programs under the Value-Based Insurance Design (VBID) model, which seeks to […]

CMS Spells Out Expanded Skilled Nursing Waiver Requirements for ACOs

The Centers for Medicare & Medicaid Services (CMS) provided details this week on what accountable care organizations (ACOs) have to do to receive waivers of the three-day inpatient stay requirement for skilled nursing care in updated guidance. ACOs consist of hospitals, physicians, and other health care providers that band together to provide care to Medicare […]

CMS Looks to Expand 3-Day SNF Waivers, Encourage Risk with New ACO Models

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized its new set of rules for accountable care organizations (ACOs), removing the no-risk tracks that represented financial drains on Medicare and expanding three-day stay waivers for nursing homes. Under the new “Pathways to Success” model, most new ACOs will only have two years to […]

CMS Warns of Therapy Scrutiny, Reveals RUG-to-PDPM Transition Details

The Centers for Medicare & Medicaid Services (CMS) on Tuesday provided details on the upcoming transition to the new Medicare payment model for skilled nursing facilities — as well as its key areas of scrutiny as the industry makes the switch. In a Medicare Learning Network call, CMS officials discussed the inner workings of the […]

Growth in Medicare Advantage Spending Far Outpaces Traditional Medicare

The growth in overall spending on nursing homes in the United States slowed for the second consecutive year in 2017, according to the latest analysis from the Centers for Medicare & Medicaid Services (CMS) — while Medicare Advantage spending skyrocketed. All payers spent $166.3 billion at nursing care facilities and continuing care retirement communities (CCRCs) […]

Trump Cabinet Calls on States to Eliminate Certificate of Need Laws

Three prominent members of the Trump administration called on individual states to eliminate Certificate of Need (CON) laws regarding the development of new health care facilities — including nursing homes — characterizing the statues as anti-competitive and detrimental to consumers. Writing in a sweeping, nearly 120-page report on health care reform, the secretaries of the […]

OIG Touts Nearly $3B in Medicare, Medicaid Fraud Recoveries in Fiscal 2018

The Department of Health and Human Services’ top fraud watchdog recovered nearly $3 billion from providers in fiscal 2018, a figure that included more than $18 million in improper payments at nursing homes. The HHS Office of the Inspector General (OIG) touted its $2.91 billion haul in its most recent semiannual report to Congress, released […]

CMS Implements Stricter Nursing Home Staffing Survey Rules for States

The Centers for Medicare & Medicaid Services (CMS) announced Friday that it will use payroll-based journal (PBJ) data to bolster state oversight of nursing homes, effective immediately. Specifically, CMS will use PBJ data to identify and provide state survey agencies with a list of nursing homes that have several days in a quarter without a registered […]

CMS Peels Back Curtain on Why Providers Receive PBJ Audits

As part of the federal government’s effort to verify staffing levels at skilled nursing facilities, skilled nursing facilities are rated on their nursing and caretaking personnel based on payroll records. How the government assesses those records has raised questions among providers, and the Centers for Medicare & Medicaid Services (CMS) recently gave Skilled Nursing News a […]

CMS to Cut Medicare Payments for 73% of SNFs Under Value-Based Purchasing

Nearly three-quarters of skilled nursing facilities will see Medicare reimbursement penalties after failing to hit certain readmission improvement benchmarks, according to a new set of data from the Centers for Medicare & Medicaid Services (CMS) Of the just under 15,000 facilities that reported sufficient data, 73% — or nearly 11,000 buildings — had incentive payment […]

CMS Trumpets Telehealth Potential in Skilled Nursing and Long-Term Care

The Centers for Medicare & Medicaid Services (CMS) issued yet another sign of support for expanding the use of telehealth services in skilled nursing facilities, pointing to a variety of studies that show the technology can save the government money. Writing in a mandated report to Congress released earlier this month, CMS highlighted multiple areas […]

CMS to Use Provider Fines to Develop Nursing Home Safety Resources

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced an initiative to divert some of the money it collects in provider fines to fund general nursing home improvement initiatives. The three-year Civil Money Penalty Reinvestment Program (CMPRP) will use a portion of nursing home penalty cash to pay for the development of toolkits […]

New Medicare Advantage Telehealth Rules Signal Growing Skilled Nursing Opportunity

New guidelines that could open up telehealth coverage under Medicare Advantage represent a serious opportunity for the industry, according to multiple technology providers — especially as the moves signal growing support for remote care from key federal officials. Under a proposed rule released late last month, the Centers for Medicare & Medicaid Services (CMS) would […]

Five-Star Ratings Don’t Tell Consumers, Investors About Skilled Nursing Safety

Consumers and investors may rely on the five-star rating system for nursing homes to make key decisions, but a new study suggests that there isn’t much difference in resident safety between buildings along the scale. “Our results reveal that Nursing Home Compare, a policy initiative aimed at improving quality and empowering consumers to make better […]

Senators Blast Nursing Home Operators, CMS Over Emergency Prep Rules

Members of a prominent Senate committee on Friday released a scathing report on emergency preparedness in the nation’s nursing homes, accusing both operators and the federal government of failing residents during storms and other disasters. Compiled by the Democratic members of the Senate Committee on Finance, the report — titled “Sheltering in Danger” — specifically […]

CMS Highlights Key Areas of Skilled Nursing Enforcement, Improvement

Improving surveys, clarifying nursing facilities’ reporting requirements, and providing more detail on citations are some of the current top priorities for the Centers for Medicare & Medicaid Services (CMS). Karen Tritz, director of the Division of Nursing Homes in CMS’ Quality and Safety Oversight Group, walked through several policies and their status in a presentation […]

CMS Moves to Expand Telehealth Coverage Under Medicare Advantage

The Centers for Medicare & Medicaid Services on Friday unveiled a proposal that the agency says will expand telehealth coverage to enrollees in Medicare Advantage plans. Under the proposed rule, which would take effect in calendar year 2020, Medicare Advantage plans could cover telehealth services for both rural and urban enrollees, as well as in-home […]

CMS Releases New Quality Benchmark Data for Skilled Nursing Facilities

Skilled nursing providers now have a new public set of nationwide quality benchmarks to see how their facilities stack up. The Centers for Medicare & Medicaid Services (CMS) on Wednesday publicly released its Quality Reporting Program (QRP) data for skilled nursing facilities, listing five key measures derived from both assessments and claims. Available on the […]

Top Tips for Skilled Nursing Providers to Win Under the New CMS Rules

The Patient-Driven Payment Model (PDPM) has gobbled up most of the recent headlines in the skilled nursing industry regarding new regulations, but there’s another set of rules that providers shouldn’t forget about. The industry remains in the thick of the new Requirements of Participation, which the Centers for Medicare & Medicaid Services (CMS) will finish […]