Lawmakers are raising concerns about the Centers for Medicare and Medicaid Services’ (CMS) new Risk-Based Survey program for nursing homes, warning in a letter Tuesday that shortened inspections could put thousands of residents at risk. In the letter addressed to CMS Chief Dr. Mehmet Oz, Sens. Elizabeth Warren, D-Mass., and Mazie K. Hirono, D-Hawaii, expressed […]
CMS
The top 10 states with the most nursing home citations tied to insufficient staffing so far this year include Iowa, Illinois and California, among others. An analysis of data from the Centers for Medicare and Medicaid Services (CMS) by the Iowa Capital Dispatch shows that staffing violations don’t result in fines or any other financial […]
The Centers for Medicare and Medicaid Services (CMS) and states have launched a $275 million initiative to recruit and retain nurses in nursing homes, with students and licensed nurses qualified for up to $40,000 in student loan repayment, and/or a $10,000 stipend. In exchange, nurses must serve in a qualifying nursing home for three years; […]
New federal limits could reduce funding for nursing home services by billions of dollars, according to an analysis published Wednesday. These payments total an estimated $3.7 billion annually, including $2.2 billion in federal funding. Potential cuts could strain nursing home finances, reduce Medicaid bed availability and limit residents’ access to care. The 2025 federal budget […]
As lawmakers aim to overhaul the nation’s long-term care (LTC) system, with proposals addressing nursing home ownership transparency and staffing standards, providers are seeking adjustments while expressing support for many of the proposed changes. Senate Finance Committee Democrats, led by Ranking Member Ron Wyden, who issued a request for information (RFI) on Friday, are seeking […]
As occupancy gains slow and lower-reimbursing managed care plans continue to reshape patient admissions, skilled nursing providers must focus on right-sizing occupancy rather than simply filling beds, according to CliftonLarsonAllen’s 41st Annual SNF Cost Comparison and Industry Trends Report, released Friday. The report includes managed care data for the first time. And future profits for […]
The value-based care payment model, Transforming Episode Accountability Model (TEAM), is confronting challenges related to communication and interoperability across hospitals and nursing homes, including the timely identification of potential TEAM-eligible patients. Moreover, some clinical leaders believe the three-day inpatient stay waiver for TEAM could use a revamp to include additional episodes of care to account […]
The latest update to the Minimum Data Set addresses a major concern for providers facing state case-mid audits and medical reviews, which often demand additional or conflicting documentation. But these updates by the Centers for Medicare and Medicaid Services (CMS) to the MDS 3.0 Resident Assessment Instrument (RAI) manual, which are due to be implemented […]
Nursing homes have only reached the tip of the iceberg when it comes to mental health challenges in the sector, with such challenges affecting quality metrics (QMs) and reimbursement amid renewed monitoring of antipsychotics use in facilities. Operators must start preparing now for behavioral health needs in residents, equipping themselves to handle multiple patient populations. […]
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 […]
With greater scrutiny of case-mix growth and coding, nursing homes should be strengthening documentation. Operators should also prepare now for expanded MDS reporting requirements beginning in 2029, reimbursement experts said. To be sure, the Centers for Medicare and Medicaid Services (CMS) is not implementing a case-mix adjustment in the FY 2027 final rule, but the rule’s language makes clear […]
Nursing home operators are getting a clearer picture of the Medicaid-rate environment – modest increases for most, while other states are seeing no change. Eleven states have reported their Medicaid rate cycle turnover since July 1, with West Virginia seeing the highest median rate increase of 3.3%, followed by Indiana with a 2.5% increase and […]
Survey changes, value-based care and other regulatory updates are shaping how operators hire and build clinical teams. As regulatory priorities shift and staffing conditions stabilize, nursing home hiring is increasingly driven by specialized expertise and a clearer sense of accountability to a company’s core values. And while federal policy actions, such as greater scrutiny of […]
Nursing home validation audits so far show MDS coding gaps tied to insufficient or missing documentation, often because of inadequate record-retention practices. And while penalties currently focus mainly on submission timelines, federal agencies could use the findings to inform future regulations related to quality reporting, experts said. MDS accuracy and documentation are a growing area of scrutiny […]
Older adults with newer, more complex medical conditions were more likely to leave a Medicare Advantage plan for traditional Medicare, and this likelihood increased as medical complexity increased, according to a new study released Friday. The study published in the JAMA Health Forum builds on earlier research showing that people who develop serious illnesses, including cancer, were more likely to leave MA. In the latest exploration, the researchers […]
In the upcoming era of risk-based surveys, consistency in storing and accessing patient data across facilities, especially following mergers and acquisitions, is ever more important. Providers will have to reconcile with some things remaining the same, however, including surveyor subjectivity. Even as the change to the risk-based survey process has been lauded by the sector […]
Minimum Data Set (MDS) submissions are about to become a lot more complicated for skilled nursing facilities (SNFs), as the Centers for Medicare & Medicaid Services (CMS) places greater emphasis on the accuracy and timeliness of quality reporting while tightening the MDS reporting window in its final payment rule. Under the FY 2027 SNF Final […]
Constant policy changes with already excessive compliance in place have long been a source of burnout for nursing home staff. But for skilled nursing industry veteran, Lisa Chubb, chief nursing officer for Venza Care, creating a culture designed specifically to support staff, what she refers to as “putting your oxygen mask on first, ” has […]
The nursing home industry has generally welcomed the risk-based survey approach announced last month by the Centers for Medicare and Medicaid Services (CMS), which rewards high-performing facilities with surveys that take half the time and require fewer surveyors. But the new surveys aren’t simply a Five-star ratings shortcut. CMS created an eligibility test that only […]
Nursing home surveys in Iowa have tightened up after falling behind federal standards in previous years, with inspections now occurring every 12 months on average. In 2024, nursing homes in the state were inspected every 17.1 months on average, exceeding the federal limit of 12.9 months according to the Iowa Department of Inspections, Appeals and […]
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