CMS final rule for skilled nursing facilities

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

#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

Interesting read

💥 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 This outdated policy restricts access to necessary skilled nursing facilities for our sickest seniors and results in unexpected, high out-of-pocket costs due to changes in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.

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

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.

🌟 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

Long-term care stakeholders and Medicare beneficiaries are applauding a new federal rule that makes it easier for patients to appeal hospital recoding that leaves them ineligible for Medicare skilled nursing care coverage. The Centers for Medicare & Medicaid Services quietly issued a final rule Oct. 11 granting patients greater power to appeal hospitals’ re-tagging of significant stays as outpatient, or under “observation” status, after initially being labeled inpatient. The difference between the observation/outpatient and inpatient labels is critical for those needing subsequent skilled nursing care. For traditional Medicare to cover SNF care, there first must be a three-day Medicare-approved inpatient hospital stay. #medicare

🚨 **Important Update for Skilled Nursing Facilities!** 🚨 On July 31, 2024, CMS released the final 2025 PPS rule, bringing significant changes for skilled nursing facilities. Here are the key highlights: 🔹 **4.2% Increase in Medicare Part A Payments:** SNFs will receive an approximate $1.4 billion boost, which includes a 3.0% market basket increase, a 1.7 percentage point forecast error adjustment, and a 0.5 percentage point productivity adjustment. 🔹 **Updated SNF Market Basket & Wage Index:** Reflecting the 2022 base year, CMS has adjusted the wage index using Core-Based Statistical Areas, aiming for more accurate payments aligned with current economic conditions. 🔹 **PDPM Changes:** Updates to ICD-10 code mappings will lead to more accurate diagnoses for patients during Part A SNF stays. 🔹 **Enhanced Penalties for Safety Violations:** CMS will now impose more consistent civil monetary penalties, ensuring higher standards of care and prompt corrections of deficiencies. 🔹 **New Quality Reporting Program Items:** The SNF Quality Reporting Program will now include four new SDOH items and a revised transportation item, improving data collection and addressing adverse social conditions impacting health outcomes. These updates are designed to enhance the quality of care in SNFs nationwide. For a detailed overview, check out the official CMS press release. (https://lnkd.in/gzCbRaEA) #healthcare #skillednursing #medicare

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