CMS Ends Nursing Home COVID Waivers Related to Discharges, Transfers, and MDS Timelines

The Centers for Medicare & Medicaid Services (CMS) announced on April 8 that it is ending several emergency regulatory waivers that were designed to give nursing homes flexibility in responding to the COVID-19 pandemic — specifically related to patient transfers and discharges, as well as the timeframe requirements for completing and transmitting a patient’s Minimum […]

Managed Care Companies Take Lead on PDPM Denials — But CMS Could Step Up Scrutiny During 2021

Over the course of 2020, as skilled nursing facilities battled the COVID-19 pandemic, the Patient-Driven Payment Model (PDPM) was one of the bright spots for operators, allowing them to secure payments for caring for the clinical needs of patients at a time when those needs grew markedly more complex. The Centers for Medicare & Medicaid […]

With Infection Control in Spotlight, $237M Program for Nursing Homes Shows Promise for COVID and Beyond

Good infection control standards are the same for skilled nursing facilities across the U.S. — both in the sense of federally mandated requirements, and in the sense of the concrete conditions that are necessary to prevent the spread of contamination. This was true even before a pandemic that shook the world in 2020, with ongoing […]

As Pandemic Drags On, Home Health Diversion Rates from Nursing Homes May Become Permanent

Occupancy at the nation’s nursing homes cratered during the COVID-19 pandemic, as hospitals suspended non-emergency surgeries and families looked to avoid institutional care settings for their loved ones at all costs. During the initial coronavirus wave last spring, leaders in the sector hoped that the second half of 2020 would bring a return to normalcy […]

AARP Sues CMS Over Reduced Fines for Nursing Homes, Claiming Move Put Seniors in Danger

The AARP Foundation and the law firm Constance Cannon filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) and outgoing Department of Health and Human Services (HHS) secretary Alex Azar, alleging that the federal government put nursing home residents’ lives in danger by weakening enforcement of monetary penalties for nursing homes. The […]

COVID Support Will Not Save Flawed Nursing Home Operators in 2021 as Distress Looms Large

When the effects of the COVID-19 pandemic in skilled nursing facilities became apparent after the first major outbreak in the state Washington, dire predictions for the sector were immediate. Most of those fears, clinically speaking, were borne out horrifically over the course of 2020. But while surveys have found plummeting occupancy and significant numbers of […]

Verma Calls for Outcomes-Based Nursing Home Reform: Despite Aid, ‘Far Too Many Residents’ Have Died

The U.S. regulatory process for skilled nursing facilities needs to be overhauled to focus on outcomes, Seema Verma, the outgoing administrator for the Centers for Medicare & Medicaid Services (CMS), argued in an opinion piece published January 8. “Despite nursing homes receiving infection control guidance, government-funded testing, training, supplies, staffing, and over $7 billion in […]

CMS Finalizes Proposed Cuts to Medicare Part B Therapy Services for 2021, Expands Telehealth Coverage

The federal government on Tuesday finalized its proposed physician fee schedule for the 2021 calendar year, formalizing cuts to Medicare reimbursement rates for therapy services provided to residents covered under Part B — while also expanding some telehealth flexibilities offered during COVID-19. The Centers for Medicare & Medicaid Services (CMS) in August floated a 9% […]

New Wave of ‘One-Sided’ Managed Care Contracts Could Lead to Payment Strains for Nursing Homes

Some aspects of the nursing home world do not change even during a global pandemic, and that includes the need to manage relationships with multiple payers. Several managed care organizations (MCOs) are now sending in their new contracts to skilled nursing providers as old agreements expire, Chad Bogar, the founder and CEO of the law […]

Former CMS Chief: Feds Must Reimagine Nursing Home Enforcement with Sharper Sticks — and Smarter Carrots

The discussion of how to improve nursing homes, especially in the wake of the still-unfolding COVID-19 tragedy, tends to divide observers into two broad camps: the industry partisans who call for more collaboration from the federal government and better funding, and the sharp critics who insist regulation should primarily — if not exclusively — take […]

CMS to Retire Old Nursing Home Compare Site on December 1

The end is near for the older version of the federal government’s primary consumer-focused nursing home resource. The Centers for Medicare & Medicaid Services (CMS) will formally phase out its eight original Compare tools — including Nursing Home Compare — on December 1 in favor of its new unified Care Compare site. CMS unveiled the […]

OIG to Probe Improper Nursing Home Discharges, Evictions

The federal government’s top health care watchdog last week announced a plan to investigate whether nursing homes are following rules around discharges, specifically citing media reports about improper evictions from facilities. The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) added a probe of facility-initiated discharges to its formal work […]

CMS, Medicare to Cover COVID-19 Antibody Drug in Nursing Homes

The federal government this week announced that Medicare will cover a recently approved antibody treatment for COVID-19 in a range of settings, including nursing homes. The Food and Drug Administration on Monday cleared on an emergency basis the use of bamlanivimab — a monoclonial antibody infusion — for adults with mild to moderate cases of COVID-19. […]

Verma: COVID-19 Shows LTC ‘Relies Too Heavily on Nursing Homes’

The nation’s top Medicare and Medicaid official this week called on states to boost their home- and community-based services for the elderly, arguing that the impact of COVID-19 on nursing homes has exposed a key flaw in the overall system. “The COVID-19 crisis has shone a harsh light on the human costs of a long-term […]

Verma Pushes Back on Criticism of CMS Response to Life Care COVID Outbreak: ‘Our Inspection Was Critical’

The nation’s top Medicare official took to Twitter to respond to a mainstream news report critical of the federal government’s handling of the first major COVID-19 outbreak at a skilled nursing facility. “60 Minutes” this past Sunday profiled that outbreak — which devastated a Life Care Centers of America facility in the Seattle suburb of […]

CMS to Relax Medicare Billing Rules to Speed COVID-19 Vaccine Distribution in Nursing Homes

The federal government on Friday announced its intention to relax restrictions around billing Medicare for immunization in nursing homes, with the stated goal of speeding the eventual distribution of a COVID-19 vaccine. Skilled nursing facilities are typically required to bill Medicare directly for immunizations under the terms of the Social Security Act, even if the […]

Verma: Alternative Payment Model Performance ‘Deeply Concerning,’ More Mandatory Programs Ahead

The nation’s top Medicare official this week expressed serious disappointment in the performance of alternative Medicare payment models, citing key design flaws and promising more mandatory programs to come. The Centers for Medicare & Medicaid Services (CMS) recently completed an analysis of several early attempts at value-based payment structures, with administrator Seema Verma disappointed in […]

HHS Warns Against Using Antigen Results for Nursing Home Cohorting, But Sharply Criticizes State Ban

A top U.S. coronavirus testing czar had harsh words for a Nevada directive banning the use of antigen point-of-care COVID-19 tests in skilled nursing facilities during a press call on Friday, calling it “an uninformed and unlawful unilateral prohibition.” But Department of Health and Human Services (HHS) assistant secretary for health Adm. Brett Giroir also […]