Washington, D.C. — The U.S. Department of Health and Human Services has deferred more than $1 billion in federal Medicaid payments to California and Minnesota, a move that nursing home operators fear could ripple through the sector and tighten already strained budgets. Approximately $867.5 million in payments to California and $199 million to Minnesota are now on hold, according to an HHS statement issued Tuesday. The agency said focused financial reviews found claims in both states that require additional documentation before federal matching funds are released. Nursing homes in both states stand to feel the impact. California directed $981.4 million…
Author: Ahuva S
The Centers for Medicare and Medicaid Services is rolling out a major overhaul of how it inspects nursing homes, and the changes could reshape daily life for operators across the country. Starting in September, CMS will launch a nationwide Risk-Based Survey process that streamlines inspections for high-performing facilities while directing more resources toward homes with weaker track records. The agency announced the move Thursday, framing it as a way to modernize oversight amid years of budget strain. The problem isn’t new. Federal funding for state survey agencies has stayed flat for a decade even as complaint investigations have jumped more…
Washington, D.C. — Nursing homes could be in for a rare regulatory win this summer. The Centers for Medicare & Medicaid Services is preparing a proposed deregulation rule that could drop as early as August, and industry groups are already lining up with a long list of what they’d like to see cut. The rule, titled “Cutting Administrative Requirements for Excellence in Patient Care,” is currently under review at the White House Office of Management and Budget. In an OMB filing, CMS said the rule would target “obsolete, outdated, and excessively burdensome regulations that can be eliminated or reformed to…
Pittsburgh, Pennsylvania — Two skilled nursing operators in the Pittsburgh suburbs thought they had a clever argument: the government never actually lost money, so why should they pay $15 million in restitution? A federal appeals court just demolished that logic. The U.S. Court of Appeals for the Third Circuit on Tuesday upheld the convictions of Brighton Rehabilitation and Wellness Center and Mount Lebanon Rehabilitation and Wellness Center, finding that both facilities systematically falsified staffing records to keep Medicare and Medicaid dollars flowing despite chronic understaffing. A federal jury had convicted the operators in December 2023. Trial evidence showed that employees…
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…
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,…
