News
States push CMS for new staffing rule targeting for-profit nursing homes, related party payers
8+ hour, 47+ min ago (509+ words) Attorneys general in 18 states have asked the Centers for Medicare & Medicaid Services to reconsider its repeal of the nursing home staffing mandate and to recast a rule focused on for-profit providers. CMS in December issued an interim final rule revoking…...
Providers lock in on ratings, I-SNP rules and denials ahead of final ‘27 MA rule
1+ day, 8+ hour ago (1036+ words) Provider groups are calling on the Centers for Medicare & Medicaid Services to adopt new rules that hold Medicare Advantage plans more accountable for "egregious" denials while also helping to ensure the future success of the only such plans nursing homes…...
State order forces fair Medicare Advantage contracts, faster pay and fewer denials. But can it succeed?
5+ day, 8+ hour ago (801+ words) A new Oklahoma executive order on Medicare Advantage may go further than any other state initiative to rein in practices largely seen as unfavorable to both beneficiaries and providers. Nursing home operators are among those anxiously awaiting details on how…...
An ‘implausible’ CMS PDPM audit puts providers on edge
6+ day, 13+ hour ago (189+ words) The OIG said the November audit was the first in a series to evaluate PDPM use. Pinnacle Multicare Nursing and Rehabilitation Center in the Bronx, NY, was out of compliance in 99 of 100 sampled Patient Driven Payment Model claims and should…...
Ask the payment expert about... Changes to the SNF VBP Program
1+ week, 1+ hour ago (171+ words) Total Nursing Hours per Resident Day is derived from PBJ and MDS data and refl ects staff ing adequacy and resident acuity. Nursing Staff Turnover is based on PBJ data and captures workforce stability and its impact on care quality....
Incentives come undone? Skilled nursing providers fight for $1B back pay and a program’s future
1+ week, 1+ day ago (516+ words) Ohio skilled nursing providers are fighting a two-fronted funding battle, hoping to capitalize on quality investments they've already made and to ensure the state continues to fully support a landmark incentive program. In September, the state Supreme Court agreed with…...
Amid Medicaid stagnation, expect federal changes to accelerate: ATI
1+ week, 5+ day ago (344+ words) While states are putting innovation on the backburner to focus on operational improvements to Medicaid, providers should expect more fast-paced changes affecting long-term care from federal policymakers in 2026. That's a key takeaway from ATI Advisory's 2025 Market Recap and 2026 Outlook, which…...
Medicare Advantage nursing home denial practices shredded by appeals contractor research
1+ week, 6+ day ago (961+ words) A deep dive into the work of one Medicaid contractor is offering stark new insights into how often Medicare Advantage plans deny nursing home coverage, how they time their decisions and why it matters to patients and providers. Acentra Health,…...
With no way to account for MA pressures, MedPAC recommends a 4% pay cut for nursing homes
2+ week, 5+ day ago (280+ words) A Congressional advisory group on Thursday voted to recommend a 4% pay cut for skilled nursing providers next fiscal year, but members also renewed calls to look at payments outside of the traditional Medicare program when making future reimbursement decisions. The…...
Corporate said so
2+ week, 6+ day ago (269+ words) Some of the most amazing nursing homes I've seen in my career are of the mom-and-pop variety. But the number of these in the U.S. has dramatically diminished." This shift has coincided with the rise of a corporate mentality in post-acute…...