A key Medicaid advisory body appears ready to recommend new appeal opportunities for millions of Managed Medicaid beneficiaries and to add more oversight to better ensure plans cover medically necessary...
MedPAC pushes 3 percent Medicare SNF cut in report to Congress
By
Kimberly Marselas
Mar 17, 2023
A key body that advises Congress on Medicare policy is calling for a 3% reduction in payments to skilled nursing facilities in fiscal year 2024.
Bill would use CMS’s Five-Star system to punish consistently 1-star nursing homes
By
Joe Bush
Oct 10, 2022
A bill that would use the federal government’s Five-Star ratings system as a means to identify and punish poor quality nursing homes passed a New Jersey senate committee Thursday, drawing criticism in...
As Medicaid disenrollments surge, concerns about nursing home residents persist
By
Jessica R. Towhey
Jun 05, 2023
Although hundreds of thousands have been knocked off state Medicaid rolls this spring, worries about dropped coverage for Medicaid-dependent nursing home residents have so far not proven reality in large...
Fasten your seatbelts: It MIGHT be a bumpy ride
By
Steven Littlehale
Oct 13, 2023
It’s been a flurry of activity leading up to the implementation of the “new MDS.” For months our industry has been doing what we do best — rising to the occasion. Countless MDS training sessions,...
Ask the legal expert … about a potential Medicaid audit
By
Norris Cunningham
Jan 25, 2023
I heard that the Office of Inspector General’s Work Plan for 2023 includes a CMS audit of Medicaid nursing facility use of funds related to direct patient care. Should I be concerned?
Providers ‘on notice’ as CMS pressures states to shift Medicaid pay metrics
By
Kimberly Marselas
Nov 10, 2022
Providers still struggling to accurately capture diagnoses that drive federal reimbursement will be doubly left behind as more states start to use Patient Driven Payment Model-like systems to determine...
CMS allows troubled California facility to keep residents, restart Medicare, Medicaid participation
By
Joe Bush
Oct 14, 2022
The Centers for Medicare & Medicaid Services granted a huge and problem-plagued nursing home in San Francisco a new lifeline this week.
Lawmakers seek to bolster Medicare, Medicaid mental health coverage
By
Alicia Lasek
Dec 07, 2022
Senators cited constituent concerns about so-called ghost networks — listings of physicians who are unavailable to provide care.
The Medicaid LTC snafu
By
Stephen A. Moses
Apr 15, 2024
Long-term care operators were sold a pig in a poke. When Medicaid started paying for nursing home care after 1965, it looked like a pretty good deal. The new revenue stream vastly expanded severely limited...