The Centers for Medicare and Medicaid Services (CMS) is making several updates to the Nursing Home Care Compare tool to improve accuracy and transparency, it stated in a memo Wednesday. The federal agency will begin posting “aggregated” performance data for nursing home chains in a clear, consumer-friendly format. Since 2022, CMS has released ownership data linking […]
A report released Monday by the Office of the Inspector General (OIG) is recommending that the Centers for Medicare and Medicaid Services (CMS) strengthen its oversight of nursing home staffing by enhancing how it uses Payroll-Based Journal (PBJ) data. The OIG is urging the federal agency to flag all nursing homes that provide fewer than […]
Proposed Medicaid cuts are spurring widespread concern among nursing home providers, as reductions would severely impact care quality, staffing, and facility operations. Activity on the Hill and a new report puts the spotlight on potential impact to stakeholders. About 92% of providers are concerned about further Medicaid cuts, according to a May report from the […]
Nursing home stakeholders remain cautiously optimistic regarding Medicare Advantage plan audits announced by the Centers for Medicare and Medicaid Services (CMS) last month, but many hope the agency will extend the same scrutiny to prior authorizations, AI usage and internal coverage criteria. Operators are unlikely to face reimbursement cuts as a result of the audits, […]
While Medicare Advantage claim denials represent 17% of initial claim submissions, including those submitted by nursing home providers, about 57% of these denials are ultimately overturned. However, MA claim denials result in a 7% net reduction in provider MA revenue, due to the dollar-weighted share of claim denials that were not overturned, according to a […]
The federal government is challenging an April ruling that struck down key provisions of the Biden-era nursing home staffing mandate. On Monday, the Department of Health and Human Services (HHS) notified the U.S. District Court for the Northern District of Texas that it is appealing the decision to the Fifth Circuit Court of Appeals. The […]
The Centers for Medicare & Medicaid Services (CMS) on Friday released a draft version of the Minimum Data Set (MDS) with four Section R items removed. In the prospective payment system (PPS) proposed rule for skilled nursing facilities (SNFs), released last month, CMS floated the removal of these MDS items, which assess elements related to […]
Legislation to streamline and improve outdated prior authorization processes for Medicare Advantage (MA) was reintroduced this week. The Improving Seniors’ Timely Access to Care Act would require MA plans to adopt an electronic prior auth system with standardized transactions, and improve transparency around MA prior auth use and requirements. It’s the third time this legislation […]
The current nursing home market has its share of positives and negatives midway through 2025, with operators enjoying Medicare and Medicaid reimbursement increases as well as a decline in facility supply, creating higher competition among buyers. Buyers are being more aggressive in the acquisition process, he said, with fewer facilities available. Brokerage firms are seeing […]
The new direction of the Centers for Medicare and Medicaid Services (CMS) renews focus on harmonizing payments across care settings – a shift that could impact nursing home profits – even as the federal agency’s commitment to advancing value-based care (VBC) remains strong. In a meeting held by the Center for Medicare and Medicaid Innovation […]
Cost-cutting measures in nursing homes, particularly food budgets, have been a concerning underlying issue in the industry, with more than a quarter of facilities in the country spending under $10 per day on food per resident. An investigative report by NJ Advance Media, in collaboration with Rutgers University and data experts at SNFdata Resources of […]
The Department of Veterans Affairs (VA) has yet to address a recommendation made by the U.S. Government Accountability Office (GAO) to identify additional enforcement actions for VA nursing homes, and to ensure such facilities comply with quality standards. The recommendation was made as part of a November 2022 report to help the VA oversee these […]
Changes to nursing home survey protocols — set to take effect April 28 — are putting a sharper focus on resident rights, documentation practices, and medication oversight. The revisions demand airtight documentation, particularly around discharge, behavioral health interventions and psychotropic drug use. Of the ten area changes due to take place, providers should pay the […]
A leaked budget document from the White House shows nursing home-related changes, notably potential elimination of health care workforce programs focused on geriatrics and other aging services, and a prioritization of survey and certification funding. The “pre-decisional” document titled, “The Department of Health and Human Services (HHS) 2026 Discretionary Budget Passback,” released by Inside Medicine, […]
The Centers for Medicare and Medicaid Services (CMS) is once again delaying the deadline to file revalidation paperwork, moving it from May 1 to August 1. It’s a welcome relief for operators given that a vast majority of nursing homes haven’t completed the burdensome paperwork. Martin Allen, senior vice president of reimbursement policy at the […]
Abrupt termination notices related to Medicaid and Medicare certification for nursing homes on the Special Focus Facilities (SFF) list have picked up dramatically as of late February, often occurring without warning or giving facilities the chance to demonstrate improvement. As a result of these abrupt terminations, nursing homes on the list have closed, including 143-bed […]
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on Friday outlining Medicare payment policy and rate updates for skilled nursing facilities under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year 2026, as part of its annual update requirements. For fiscal 2026, CMS plans to increase SNF PPS […]
After a federal judge in Texas vacated the nursing home staffing rule on Monday, operators are rejoicing, though some legal experts in the sector suggest the fight may not be over just yet. “This is a really strong decision on both prongs of the staffing mandate. It hits all of the relevant points as to […]
A federal judge for the U.S. District Court of Northern Texas on Monday threw out the federal nursing home staffing mandate, while just Thursday the Trump administration defended the staffing rule in a brief filed in the U.S. Court of Appeals for the Eighth Circuit. Judge Matthew Kacsmaryk of the U.S. District Court for Northern […]
The Centers for Medicare & Medicaid Services (CMS) issued a final rule Friday to modernize and improve several Medicare programs, including Medicare Advantage (MA), but it does not include new restrictions on MA plans’ use of artificial intelligence. The rule for contract year 2026, effective June 3, introduces changes to prescription drug coverage, the Medicare […]
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