Kennebunk, Maine — After emerging from a high-profile bankruptcy, Genesis Healthcare isn’t just trying to stay afloat. The company is rebuilding its entire operating playbook, and early signs suggest the strategy is working. Genesis has rolled out a locally structured “pod model” that groups three to four facilities under a single pod leader, typically an administrator who stays close to the bedside rather than getting pulled into corporate bureaucracy. It’s a deliberate shift away from the top-down management structure that plagued the company before its Chapter 11 filing, and it’s already producing measurable results. According to company executives, early pilot…
Author: Ahuva S
WASHINGTON — When a federal investigator starts asking questions about your denial rates, you know something’s off. That’s exactly what happened last month when the Department of Health and Human Services’ Office of Inspector General dropped not one, but two reports on how Medicare Advantage plans handle requests for nursing home admissions. The findings weren’t subtle. Among the 19 largest Medicare Advantage organizations, the denial rates for skilled nursing facility admissions ranged from a eyebrow-raising 23 percent down to just 0.4 percent. But here’s where it gets interesting: when patients or their doctors actually bothered to appeal those denials, the…
Washington, D.C. — The Department of Justice’s Office of Legal Counsel dropped a bombshell memo last week that could upend nearly three decades of disability rights law, and nursing homes are suddenly sitting in the middle of a much bigger political fight. On June 18, four days before the 27th anniversary of the landmark Olmstead v. L.C. Supreme Court decision, the DOJ’s OLC concluded that the Rehabilitation Act and the Americans with Disabilities Act do not actually impose “integration mandates” on states. In plain English, the memo says states are not legally required to keep people with disabilities out of…
Burlington, Vermont — A federal judge has cleared the way for a civil rights trial against Elderwood at Burlington, a one-star nursing home accused of allowing white residents to racially harass Black employees for months without stepping in. The U.S. Equal Employment Opportunity Commission filed suit in 2022, alleging that six Black staff members endured repeated verbal and physical assaults rooted in race. Supervisors were informed, according to the complaint, but the facility failed to act swiftly or effectively to stop it. In March, Chief District Judge Christina Reiss denied the operator’s request to dismiss the case without a trial.…
Washington, D.C. — Medicare Advantage plans denied roughly 12% of requests to admit patients into skilled nursing facilities, then quietly reversed nearly all of those denials when families pushed back. That’s the headline finding from a federal Office of Inspector General report posted Thursday, and it’s already reshaping the conversation about prior authorization on Capitol Hill. OIG investigators reviewed June 2024 data from the 19 largest Medicare Advantage parent companies. Plans denied about 13,500 of 109,400 SNF admission requests. When enrollees appealed, MAOs overturned 95% of those denials in favor of the patient, according to the report. Only 18% of…
Washington, D.C. — Three Democratic senators are pressing the Centers for Medicare and Medicaid Services to revive a stalled nursing home ownership disclosure rule, telling Administrator Mehmet Oz the agency’s pause on the deadline has weakened public visibility into who actually controls the country’s skilled nursing facilities. Sens. Cory Booker (D-NJ), Ron Wyden (D-OR) and Elizabeth Warren (D-MA) sent a letter this week urging CMS to immediately reinstate a January 1, 2026 reporting deadline that was suspended through sub-regulatory guidance late last year. The deadline applied to a new SNF Attachment to Form CMS-855A, which requires facilities to disclose ownership,…
Los Angeles, California — The largest publicly operated health plan in the country is openly working to divert patients away from skilled nursing facilities, and it’s using better data and care management tools, not just slow prior authorization, to do it. That message came through clearly during a recent AHIP webinar featuring leaders from L.A. Care Health Plan, the nonprofit insurer that covers about a quarter of Los Angeles County residents. According to industry reports on the session, L.A. Care has built near real-time visibility into hospitalizations, discharges and risk scores, and it’s pushing that information to care teams while…
Richmond, Virginia — Virginia just took a closer look at its nursing home industry — and the order came straight from the governor’s pen. Gov. Abigail Spanberger signed a bill into law that requires the state’s Joint Commission on Healthcare to study how nursing homes operate, how they spend public money, and how well they actually care for residents, according to industry reports. The measure was driven by Del. Delores McQuinn, a Henrico Democrat whose district includes a facility federal regulators flagged as Virginia’s worst-performing nursing home. “The expectation was that if you owned the nursing home, that you were…
Washington, District of Columbia — More than half of Medicare fee-for-service beneficiaries are now aligned with an accountable care organization, and a former top federal innovation official says nursing homes should be moving fast to get inside that system before the next wave of payment models locks in. Purva Rawal, who recently stepped down as chief strategy officer for the Center for Medicare and Medicaid Innovation, told industry reports that ACOs have become the strongest mechanism the agency has for managing total costs while still improving outcomes — and that skilled nursing operators stand to gain by aligning early. Her…
Indianapolis, Indiana — Majestic Care says a broad certification push is starting to pay off inside its nursing homes, with company leaders pointing to stronger recruitment, better quality metrics and improved star performance across part of the portfolio. According to industry reports, Majestic Care leaders said certifications have become a practical hiring tool at a time when skilled nursing operators still face a tight labor market. Stephanie Fischer, the company’s senior director of RAI, said job candidates often ask whether the company will pay for certifications. Under Majestic’s organizational membership structure, staff can access those programs across the company, she…
