Salt Lake City, Utah — One of the country’s fast-growing skilled nursing operators says it heads into 2026 with momentum — but its chief operating officer isn’t sugarcoating the road ahead.
Larry H. Miller Senior Health, the Utah-based post-acute care company, capped a strong 2025 with the acquisition of Kissito Healthcare’s six-facility Virginia portfolio. The deal added 532 licensed beds to the organization and placed the facilities under a $142 million triple-net lease with CareTrust REIT, effective January 1, 2026. The acquisition also expanded clinical offerings to include ventilator, tracheostomy, and memory care — positioning the company to serve higher-acuity patients as demand grows.
But even with that expansion, COO Andy Frasure is clear-eyed about what’s working against providers right now.
Medicare Advantage: The Burden With No Quick Fix
For Frasure, the biggest operational headache isn’t staffing alone — it’s the mounting administrative weight tied to Medicare Advantage plans. Complex billing requirements, prior authorization delays, and fragmented care transitions all pile onto a workforce that’s already stretched thin.
“We see increased administrative burden as there are demands to meet regulatory requirements, complex billing issues and fragmented care systems,” Frasure said. “We are approaching 2026 with clear priorities: improve consistency across operations, scale what works, and strengthen coordination across our continuum so patients experience smoother transitions and better outcomes.”
He’s not alone in that frustration. Industry reports have documented how Medicare Advantage plans are costing the federal government $76 billion more per year than traditional fee-for-service Medicare — a gap that comes with real consequences for skilled nursing facilities navigating prior authorizations, shorter approved stays, and inconsistent coverage policies.
Frasure said there’s no short-term fix. For now, the company is managing by investing in its leadership pipeline through administrator-in-training programs and building out staffing partnerships with international recruitment channels.
Acuity Is Rising — and That Changes Everything
Higher-acuity patients are showing up in skilled nursing beds more often, Frasure noted, partly because of where the Kissito acquisition took the company. Specialty care units for ventilator and tracheostomy patients require more intensive clinical oversight than a standard skilled nursing stay.
The company is responding by reinforcing what it calls its “Continuum of Care” model — integrating skilled nursing with home health, hospice, and assisted living under the same operational umbrella. The idea is to reduce transfer gaps and keep residents moving through the right level of care at the right time.
Despite the pressures, Larry H. Miller’s facilities have consistently earned five-star ratings under the federal inspection system — a signal that quality hasn’t slipped as the footprint has grown.
Growth, But Not at Any Cost
Frasure was careful to frame expansion as disciplined rather than aggressive. The company is evaluating new markets but won’t pursue deals that don’t fit its culture or long-term strategy.
“These additional facilities and further expansion will allow Larry H. Miller Senior Health opportunities to enter additional markets across the county,” he said, “but we are evaluating responsible growth opportunities that align with our strategy and culture.”
As more baby boomers age into Medicare eligibility, the demand for skilled nursing beds will only climb. Whether the industry can keep pace — staffed, funded, and compliant — is the open question that operators like Larry H. Miller are navigating one quarter at a time.
