As Medicare Advantage Plans Slowly Migrate from RUG to PDPM, Providers Must Avoid Lost Payments

Most Medicare Advantage (MA) plans that used the old Medicare system for calculating reimbursement for skilled nursing facilities are moving to the new system along with the federal government — at least if the early weeks of the Patient-Driven Payment Model (PDPM) are anything to go by. That said, details on contracts and changes are […]

CMS Could Soon Crack Down on States’ Medicaid Payment-Boosting Programs for Nursing Homes

In multiple states, supplemental programs help skilled nursing facilities offset the low reimbursement for their services from Medicaid. But the federal government is starting to take a closer look at the programs, with an eye to increasing transparency, Andrea Maresca, senior vice president at the consulting firm Thorn Run Partners, said during a presentation on […]

As Phase 3 Looms, Many Skilled Nursing Facilities Lack Key Required Staff

A new survey found that though antibiotic stewardship has increased at skilled nursing facilities across the country, there are still gaps with regard to the infection preventionist (IP) position -— even though that position is a key part of Phase 3 of the Requirements of Participation (RoPs) for SNFs, taking effect at the end of […]

Less Than 5% of Nursing Homes Receive Abuse Icon — But Financial Impacts Could Be Coming

As the federal government predicted, just under 5% of the nation’s nursing facilities received a new abuse warning icon on the consumer-facing Nursing Home Compare website — but the early data also reveals significant regional variations that could have an impact on valuations and bottom lines moving forward. Out of 15,262 total facilities, just 760 […]

Verma: New Abuse Warning Icon ‘Isn’t Really Going to Impact Very Many Nursing Homes’

Despite widespread anger in the skilled nursing industry, a controversial new warning icon for facilities with previous reports of abuse and neglect will affect only a relatively small proportion of properties, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma told lawmakers in Washington on Wednesday. Testifying before the House Committee on Energy & […]

Providers, CMS Must ‘Band Together’ to Improve Skilled Nursing Care for Behavioral, Mental Health Patients

In a health care landscape full of challenges, staffing consistently ranks as the top concern for skilled nursing facilities. But the second-most prevalent concern is patients and residents who have mental health needs and substance use disorders, according to a top federal official — and there are no easy answers for how SNFs should cope. […]

Therapy Cuts Were ‘Inevitable’ Under PDPM — and Providers Must Prepare for Possible Payment Drops

Reports of therapist layoffs and cuts in therapy hours hit the news within days of the implementation of the new Medicare reimbursement system for skilled nursing facilities, sending shock waves throughout the rehab provider community. But according to one major skilled nursing trade group, the cuts to therapy were baked into the system of the […]

‘CMS is Watching’: Changing Therapy Patterns Raise Concerns About Skilled Nursing Audits, Care Quality

The first week of the new Medicare payment model for nursing homes has brought stories of rapidly shifting therapy patterns among some providers, and voices from the consulting and advocacy worlds are warning that any sudden movements could cause adverse effects — both immediately and down the road. The advent of the Patient-Driven Payment Model […]

State-Level Opposition to CMS Regulatory Rollbacks for Nursing Homes Grows

The attorneys general of New York, Illinois, Maryland, Michigan, Nevada, and Oregon jointly pushed back on the delay of regulations for nursing homes, a move that came at the same time as similar criticism by California’s top attorney. The comment letter was filed September 16, the deadline for submitting comments on the proposed rule delaying […]

Why Skilled Nursing Operators Can’t Bank on ‘Silver Tsunami’ — or One Good Month Under PDPM — for Relief

As the post-acute and long-term health care industry struggles through shortened lengths of stay and compressed reimbursements, an oasis has lingered just beyond the horizon: the so-called silver tsunami. If operators can wait out the current downturn, the thinking goes, the glut of baby boomers turning 80 and older over the coming years will be […]

CMS Expands Power to Ban Providers with ‘Problematic’ Affiliations from Medicare, Medicaid

The federal government on Thursday finalized a rule that will expand its power to remove potentially unscrupulous health care providers from Medicare and Medicaid eligibility. Under the new final rule, the Centers for Medicare & Medicaid Services (CMS) can kick providers out of the programs if they have a previous affiliation with a banned organization, […]

Rethink Podcast #14: CMS Chief Medical Officer Kate Goodrich

The 14th episode of our podcast, Rethink, is now available! As the Medicare program’s top clinical official, Dr. Kate Goodrich has played a major role in the wave of nursing home regulatory scrutiny coming from Washington and Baltimore over the last few years.Goodrich and CMS administrator Seema Verma have placed skilled nursing facility compliance and […]

AHCA: CMS Already Has Authority to Simplify Three-Day Stay Rule for Nursing Home Coverage

The leading national trade group representing for-profit skilled nursing facilities this week called on the federal government to streamline its policy on Medicare eligibility for nursing home care, arguing that officials already have the legal authority to do so. American Health Care Association president and CEO Mark Parkinson formally asked Centers for Medicare & Medicaid […]

Verma: CMS Should Reduce Survey Frequency for Top Nursing Homes, Look Beyond Monetary Penalties

The leader of the Centers for Medicare & Medicaid Services (CMS) on Wednesday continued her public push for greater nursing home oversight, promising that the agency will use data to target states with suspiciously low rates of citations — while also expressing a desire to reduce survey frequencies for top performers. CMS administrator Seema Verma […]

OIG Calls on New York to Crack Down on Nursing Home Safety

The federal government’s top health care watchdog has called on state officials in New York to beef up enforcement of nursing home safety rules after uncovering multiple violations in a recent audit. The Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) this month released a report accusing the Empire State […]

Skilled Nursing Providers Could See Slight Changes in Value-Based Purchasing Penalties, Bonuses After CMS Error

Skilled nursing operators may notice some small changes to their final bonuses or penalties under a key value-based payment initiative after federal officials acknowledged a slight error in their calculations. The Centers for Medicare & Medicaid Services (CMS) on Thursday announced that it incorrectly calculated its scores for the SNF Value-Based Purchasing (VBP) initiative, according […]