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 […]
CMS finalized its 2027 Skilled Nursing Facility Prospective Payment System (SNF PPS) rule, increasing rates by 2.4%, but nursing home leaders say the shortened clinical data reporting window will increase administrative burdens. The agency’s decision is based on the final SNF market basket of 3.3%, reduced by a 0.9% productivity adjustment for an estimated increase […]
Nursing home operators may be in for a rude awakening Wednesday, when an update to the 5-Star Quality Rating System, requiring more points for ratings, goes into effect. That’s because the Centers for Medicare and Medicaid Services (CMS) is increasing quality measure thresholds by one-half of the average improvement in QM scores. While thresholds to […]
Nursing homes are increasingly leveraging artificial intelligence (AI) to streamline referral processing and case management, with the ability to reduce hospital packets to concise summaries in under a minute and cutting referral review times in half. Payer-provider relationships are expected to evolve as a result, with tech-supported documentation and care planning inspiring payer trust in […]
The U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) on Tuesday deferred more than $1 billion in federal Medicaid payments to California and Minnesota. The agencies plan to expand this deferment tool in the future. That’s approximately $867.5 million in deferred federal payments to California, and $199 million […]
As the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model winds down this year, federal findings offer insights into the future of accountable care for medically complex beneficiaries – many of whom reside in a nursing home. ACO REACH reduced gross Medicare spending by $706 million overall, the American Health Care […]
More than a fourth of nursing homes nationally reported at least one serious deficiency, with 5% of the deficiencies cited in the last survey cycle rising to the level of actual harm or immediate jeopardy (IJ) posed to residents, representing serious risks, including injury, impairment or death, according to a KFF analysis released Thursday. That’s […]
The Centers for Medicare and Medicaid Services (CMS) is launching a new risk-based survey process to “modernize” nursing home oversight by focusing inspection resources where they are most needed while recognizing high-performing facilities, the agency said Thursday. The agency noted that the changes to the survey process are driven by limited funding for nursing home […]
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule this week jam-packed with reforms to the Merit-Based Incentive Payment System (MIPS), ACO participation and the Physician Fee Schedule (PFS). Overall, CMS proposed a 1.19% decrease in the PFS conversion factor for 2027, but providers unable to participate in PFS incentive programs, including […]
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