April Shaeffer, MBA-HCA, BSN, RN, CDP, ICP, LNHA’s Post

Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost reports show a shift in operating margins with more facilities struggling financially. With insight from CLA (CliftonLarsonAllen). https://bit.ly/4hTIyJI

Fiscal Year 2025 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1802-F) On July 31, the Centers for Medicare & Medicaid Services released a final rule which includes a 4.2% net increase in Medicare Part A payments to skilled nursing facilities. The final rule revises enforcement policies to impose more consistent civil monetary penalties for health and safety violations in nursing homes. Previously, CMS could not impose per-day and per-instance penalties for the same deficiency. The new rule allows both types of penalties to be used simultaneously. The goal is to ensure facilities promptly address issues and maintain long-term compliance. To no surprise, the nursing home industry has stated its disgust with the notion of being held financially accountable for failing to keep residents safe. Source: LTCCC Policy Update <[email protected]>  CMS reference for this announcement: https://lnkd.in/gwiN2Q-i

I fell down a rabbit hole this morning at the MedPAC website--a separate commission that advises CMS on rate-setting, quality and other matters. They've released reports today on Medicare fee-for-service payments for skilled nursing, home health, etc. It's a real stat-fest! The money story is complex to say the least. People who enter a nursing home for rehab services after a hospital stay under old-school Medicare are lucrative. They create a 31% marginal profit. By contrast, people who have Medicare Advantage plans are not as good a deal for the nursing home. And people who get admitted under Medicaid, the program for poor people, cost nursing homes 18 cents on every dollar they receive. The upshot is that effectively, old-school Medicare is subsidizing not just Medicaid but also Medicare Advantage. Overall, the margin for the nations 14,500 skilled nursing facilities last year was slightly positive at 0.4%. Nothing here that's really new...just another weird corner of our crazy health care system, a fascinating rat's nest of contradictory ideas and incentives. https://lnkd.in/gR7nXxmx

🏥💼 Nursing homes get a new tool for Medicare Advantage negotiations with the TEAM model! Discover how this could reshape contracting strategies and improve care quality. #MedicareAdvantage #NursingHomes #ValueBasedCare

The bipartisan “Improving Access to Medicare Coverage Act” would allow Medicare beneficiaries' hospital observation days to count toward the three-day requirement for skilled nursing care, addressing a long-standing issue. AHCA/NCAL, along with 32 other organizations, aims to ensure access to skilled nursing care post-hospitalization, regardless of stay classification. #Medicare #skillednursingcare #legislation

Medicare Advantage is reshaping nursing home dynamics—occupancy gains but trimmed margins. Efficiency, value-based care, and quality partnerships are the path forward. 📊 #SeniorCare #HealthcareInnovation

Is long-term care covered by Medicare? Usually not. But what about skilled nursing care or rehabilitation support? Find out in today's blog post! https://lnkd.in/eXukMTY #medicaremindset #medicare

Heads Up! There are upcoming changes in the staffing domain for the July 31st Care Compare refresh that could impact the star ratings of your nursing homes. This article provides more information about the updates, including the modifications to staffing turnover measures. #MarshMMA #seniorliving #CMS

CMS issued a final rule, Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting that went into effect on June 21, 2024. This rule is intended to establish minimum staffing standards for long-term care facilities as part of the Biden-Harris Administration's nursing home reform initiative to ensure safe and quality care in LTC facilities. The rule also requires states to report the percent of Medicaid payments for certain Medicaid-covered institutional services that are spent on compensation for workers and support staff. The rule represents a pivotal change in LTC staffing standards and underscores a profound shift towards a holistic and person-centered care for residents. This insight by Marisol Cooke, JD, CHC will help organizations comply with these new standards.

💥 Action Requested: https://lnkd.in/gNJxZQX2 On April 17, 2024, U.S. Senators Sherrod Brown (D-OH), Susan Collins (R-ME), and Sheldon Whitehouse (D-RI) introduced the Improving Access to Medicare Coverage Act (S. 4137), legislation that would allow Medicare "observation status" to meet the 3-day requirement for an inpatient hospital stay before a Medicare beneficiary qualifies for covered skilled nursing care. This legislation aims to eliminate the blurred lines between observation status and admitted status, thus reducing unexpected costs, and enhancing seniors' access to necessary healthcare services. Currently, Medicare requires beneficiaries to undergo at least three days of inpatient care to access their entitled 100 days of skilled nursing services. However, many hospitals categorize seniors under ‘observation status’ instead of admitting them as inpatients — a distinction that, while subtle, has led to costly Medicare denials. This outdated policy restricts access to necessary skilled nursing facilities for our sickest seniors and results in unexpected, high out-of-pocket costs due to changes in admission status — costs billed directly to patients, bypassing Medicare coverage. During the pandemic, CMS temporarily suspended this rule during the pandemic, and we urge that Congress permanently eliminate this rule to ensure all seniors have unrestricted access to the care they require.  Contact your legislators. Take action today and urge your members of Congress to support this bill! Tell your clients to take action. You can share this Operation Shout! with your clients so they can also send a direct message to their representative.