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RIDICULOUS REGS I have continued my perusal through the longstanding Centers for Medicare & Medicaid Services regs of skilled nursing facilities (SNFs). The level of specificity of basic activities and processes is rather impressive - in a bad way. It is a classic example of the federal regulation of minutiae while ignoring the need for measuring outcomes. If anything, the CMS regs show the need to shift towards performance-based regulation and away from a checklist oversight model that reminds me of middle school teacher. As I wander through the regs, I plan to highlight some of them to bring light to how we encase the current model of care in concrete -- and force facilities to focus on compliance instead of care. From CFR 483.90 regulation of the physical environment in SNFs ----------------------------------------------------------------- A long-term care facility may install alcohol-based hand rub dispensers in its facility if the dispensers are installed in a manner that adequately protects against inappropriate access. ---- I cannot believe that this is even a reg...time for Medicare modernization...!! Deborah Williams Lisa Grabert Matthew Hittle Cambridge Neal Nina Owcharenko Schaefer Ann M. Richardson, MBA Vinod Dasa MD Dutch Rojas Clifton J. Porter II Mark Hamelburg Nisha Patel, MD, MPH Les Granow Sarah Schmidt, MPH Donald Dempsey Betty Rambur Jesse Ehrenfeld MD MPH American Hospital Association American Enterprise Institute American Public Health Association American Medical Association #healthpolicy #medicare #nursing

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

On July 31, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2025. CMS is publishing this final rule that is consistent with the legal requirement to update Medicare payment policies for SNFs annually. This fact sheet discusses the major provisions of the final rule. FY 2025 Updates to the SNF Payment Rates Changes in Patient-Driven Payment Model (PDPM) ICD-10 Code Mappings Nursing Home Enforcement Skilled Nursing Facility Quality Reporting Program Updates to the SNF QRP: Skilled Nursing Facility Value-Based Purchasing (VBP) Program Updates to the SNF VBP:

#SNF operators have always focused closely on their periodic Surveys and the resulting findings, but as of the latest Centers for Medicare & Medicaid Services final rule, the potential fines will soon increase significantly, as starting in October, operators can be fined multiple times for noncompliance within a single Survey. If you're curious about what a Survey is in #SkilledNursing, and want a relatively high-level overview, Medicare.gov has a summary here: https://lnkd.in/gW8EVACN If you want to do a really deep dive (prepare yourself for 162 pages of detail), the State Operations Manual on the topic can be found here: https://lnkd.in/gC3U-P9b Jillian Somers Donovan and Kyle Ruth-Islas, MNA LNHA RCFE are great people to follow if you want to understand more about the complex regulatory aspects of #seniorliving. #healthcare #SkilledNursingFacilities #olderadults #survey #seniorliving

🌟 CMS Final Rule: Reimbursement Boost for Skilled Nursing Facilities The Centers for Medicare & Medicaid Services (CMS) has just announced a significant update for fiscal year 2025 that impacts Skilled Nursing Facilities (SNFs). Historically SNFs have faced low margins. This could help. 📈 Payment Increase: Medicare spending for SNFs will go up by 4.2%, which amounts to $1.4 billion more than in 2024. This comprises: • +3% market basket update • +1.7% adjustment to fix a previous error • -0.5% cut for productivity 🏥 New Enforcement Rules: CMS will have more power to enforce rules and can impose stiffer financial penalties on facilities with health and safety issues. 📊 Quality Reporting Program: No quality measures are being added or removed, but SNFs will start reporting on social needs like living situations, food, and utilities starting in 2027. A new data validation process will also begin in 2027. 🔄 Value-based Purchasing Updates: CMS is refining the SNF Value-based Purchasing program, focusing on measure removal, review, and corrections. They’ve also updated how they calculate the Total Nurse Staffing measure. This is a big step towards improving care and ensuring safety in nursing facilities, which serve some of the nation's highest-need patients. Here at Radial we're encouraged to see the new focus on SNF reporting of SDOH measures. This aligns with other recent Medicare initiatives to promote health equity. #SkilledNursing #Medicare #CMSUpdate

📢 Attention Texas skilled nursing providers! In case you couldn't make it to Friday's crucial webinar discussing the proposed Patient-Driven Payment Model (PDPM) for Long-Term Care Rate Setting Methodology for Texas, fret not! We've got you covered. The Texas Health and Human Services has graciously made the webinar recording and presentation copy available on its website. You can view it here: https://lnkd.in/g4Hjs7Ch Background: Rider 25 in the 2024-25 General Appropriations Act (GAA), House Bill 1, 88th Legislature, Regular Session, 2023, mandates the development and implementation of a Texas version of PDPM for Medicaid reimbursement in long-term stay nursing facilities. This initiative, led by the Texas Health and Human Services Commission (HHSC), is aimed at elevating the quality of care provided to residents. The proposed change is scheduled to take effect September 1st, 2025. Stay informed and be part of the positive change in long-term care! #TexasHealthcare #PDPM #LongTermCare #QualityCare https://lnkd.in/g4Hjs7Ch

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

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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

Nursing facilities and skilled nursing facilities that participate in the Medicare and Medicaid programs should review the Nursing Facility Industry Segment-Specific Compliance Program Guidance, which offers guidelines that highlight risk areas that nursing facilities should consider when implementing, evaluating, and updating their compliance programs. Read our article to get up to speed: https://lnkd.in/eYnF9aJJ