I-SNPs vs. ACOs: Balancing the Skilled Nursing Risks, Rewards of Two Hot Payment Models

As the skilled nursing industry struggles to adapt to a new Medicare payment landscape, in-house Medicare Advantage plans have emerged as one of the hottest topics among leaders — while the space’s publicly traded behemoth has thrown its full support behind the separate accountable care organization (ACO) model. There may not be one set answer […]

CMS Proposes Three-Year Extension, Additional Outpatient Coverage for CJR Bundled Payment Model

The federal government on Thursday issued a proposed rule that would extend the Comprehensive Care for Joint Replacement (CJR) bundled-payment model for an additional three years — while also expanding its reach to include outpatient procedures. Initially set to expire on December 31, CJR would remain active through the end of 2023 if the Centers […]

Verma Touts Low SNF Provider Terminations, Wants to Give Operators Chance to ‘Turn Things Around’

The head of the Centers for Medicare & Medicaid Services (CMS) touted the agency’s changes around enforcement of quality and safety standards in a blog post published on Tuesday, as part of a series on its five-part strategy to improve care in nursing homes across the country. The strategy’s components include: strengthening oversight, enhancing enforcement, […]

Lawmakers: Medicaid Supplement Crackdown Would Constrict Nursing Home Supply

A group of 27 U.S. representatives asked the Centers for Medicare & Medicaid Services (CMS) to rethink a proposal restricting Medicaid supplemental payments — claiming enforcement will lead to decreased services and fewer available nursing home beds. The controversial proposed rule, the Medicaid Fiscal Accountability Regulation (MFAR), would bring tighter regulations to state-based Medicaid supplemental […]

Verma Strikes Back on MFAR: Worries Over Billions in Medicaid Cuts ‘Alarmist’ and ‘Overblown’

The head of the Centers for Medicare & Medicaid Services (CMS) on Wednesday issued a strong defense of a proposed rule that nursing home advocates claim would place up to $50 billion in Medicaid reimbursements in immediate jeopardy, framing the move as a necessary step toward reducing fraud and waste. The Medicaid Fiscal Accountability Regulation […]

White House: Site-Neutral Payment System for Post-Acute Care Would Save Medicare $100B

The Trump administration’s proposed fiscal 2021 budget, released Monday, put a price tag on a long-floated plan to unify Medicare reimbursements for post-acute services under a single, site-agnostic system: more than $101 billion over a decade. “The budget prioritizes use of the trust funds to pay for seniors’ healthcare and incentivizes quality and efficiency in […]

Bipartisan Group of 99 Lawmakers Calls on CMS to Rethink 8% Therapy Payment Cut

A group of 99 U.S. representatives, consisting of both Republicans and Democrats, this week asked the Centers for Medicare & Medicaid Services (CMS) for more information about a rule that could have a major impact on nursing home residents who receive therapy services. Under the 2020 Physician Fee Schedule (PFS) final rule, CMS implemented a […]

Winners Still Outnumber Losers in Latest PDPM Analysis, But Length of Stay Trends Could Erase Rate Gains

The latest analysis of the new Medicare payment model for nursing homes again shows more operators scoring gains than suffering losses, but the change from the previous system may not be quite as straightforward — particularly as fee-for-service Medicare continues to lose ground to other payment sources. A little more than 67% of skilled nursing […]

Tips for Early PDPM Success: Demand More Data from Hospitals, Market Higher-Acuity Services

The early returns for the new Medicare nursing home payment model have been positive, but providers aren’t seeing gains by sitting back and watching the changes. Several key strategies for success have emerged in the Patient-Driven Payment Model’s first four months, with a particular focus on data — as well as clearly communicating the availability […]

CMS to Merge Nursing Home Compare into Single, Cross-Continuum Database

The federal government on Thursday announced a major shake-up to its consumer-facing database of skilled nursing facility quality information, revealing plans to merge Nursing Home Compare into a more comprehensive website that features data about care sites across the continuum. Sometime later this year, the Centers for Medicare & Medicaid Services (CMS) will combine all […]

CMS Chief Medical Officer to Leave for Role With Insurance Giant Humana

The chief medical officer at the Centers for Medicare & Medicaid Services (CMS) will be leaving the agency next month to take a new position with health insurance heavyweight Humana (NYSE: HUM). Modern Healthcare first reported the news Thursday. CMS confirmed to Modern Healthcare that Goodrich, who has also served as director of the Quality […]

Proposed Medicaid Rule Would Mean Billions in Cuts, Waves of Nursing Home Closures

With skilled nursing facilities in multiple states facing significant shortfalls in their Medicaid reimbursement, supplemental payment programs used to bolster rates have become a lifeline. This is especially true for Texas and Indiana, both of which employ programs designed to get SNFs a higher rate for Medicaid services through varying mechanisms. Both states are motivated […]

Verma: Overhaul Led to Significant Growth in ACOs Taking on Risk, But Verdict Out on Spending

A federal overhaul to the Medicare Shared Savings Program (MSSP), implemented late in 2018, has led to an increase in the number of accountable care organizations (ACOs) taking on downside risk. The redesign of the program, dubbed “Pathways to Success,” generally required new ACOs to take accountability for spending increases after two years; previously ACOs […]

CMS Taps Anthem Vet Smith for Top Innovation, Value-Based Care Posts

The federal government on Monday announced the appointment of Brad Smith, a health care and insurance industry veteran, as the next head of the Center for Medicare & Medicaid Innovation (CMMI). Smith, previously the chief operating officer at insurance giant Anthem’s diversified business group, will additionally serve as senior advisor for value-based transformation to Department […]

As Providers Warn of ‘Broad Negative Impact,’ CMS Extends Comment Period on Medicaid Supplement Crackdown

The federal government extended the deadline for providers — both acute and post-acute — to comment on a proposed rule that would crack down on supplemental payment programs under Medicaid. The new deadline is February 1, pushed back about two weeks from the original end date of January 17. The Centers for Medicare & Medicaid […]

CMS to Remove Section G from Minimum Data Set in Fiscal 2021

The federal government in late December released draft updates to a key set of paperwork for nursing home staff, revealing a potential change ahead for 2020 and beyond. The Minimum Data Set (MDS) will no longer include Section G, the Centers for Medicare & Medicaid Services (CMS) announced in late December. “Please note that Section […]

Federal Lawmakers Resurrect Nursing Home Arbitration Ban with Proposed Bill

Two Congressional representatives introduced a bill on Thursday that would ban nursing homes from requiring — or even asking — residents to enter into mandatory, pre-dispute, binding arbitration agreements. The Fairness in Nursing Home Arbitration Act, introduced by Democratic Reps. Linda Sánchez of California and Jan Schakowsky of Illinois, has support from a range of […]