Honolulu, Hawaii — The Centers for Medicare & Medicaid Services announced emergency flexibilities and resources for Hawaii healthcare providers on April 21, following a month of devastating storms, floods, landslides, and mudslides that began March 10. HHS Secretary Robert F. Kennedy Jr. signed a Public Health Emergency declaration the same day, triggering a suite of regulatory waivers designed to keep hospitals, nursing homes, and dialysis centers operational while residents recover from the disaster. The move comes more than a month after the initial storms hit, raising questions about the timeline between disaster and federal response. What the Waivers Actually Do…
Author: Mordy Y
Washington, D.C. — A Trump administration plan to expand access to GLP-1 weight loss drugs for Medicare and Medicaid patients has hit a wall — and the fallout is being passed directly to federal taxpayers. The administration had designed a pilot program called BALANCE — short for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth — to test whether covering obesity medications like Wegovy and Zepbound would improve health outcomes and reduce long-term costs. The structure required health insurers to sign up and share the financial burden. They largely refused. According to industry reports, the program needed at least…
Sacramento, California — By the time Pearlene Darby was rushed to a hospital in 2020, she had open sores on both legs, both hips, and both heels — and a five-inch gash on her tailbone. The retired teacher died two weeks later from infections and bedsores. She was 81. Her daughter sued the nursing home. But the lawsuit didn’t stop there. It also named the building’s owner: a real estate investment trust, or REIT. Court records showed that in the year Darby died, the Sacramento facility paid CareTrust REIT more than $1 million in rent — while the nursing home…
St. Petersburg, Florida — When a nursing home lands on the federal government’s Special Focus Facilities list, it’s not a warning. It’s a verdict. The Centers for Medicare and Medicaid Services maintains a list of the worst-performing nursing homes in the country — facilities with prolonged records of serious deficiencies, repeated violations, and threats to resident safety. Only 88 of the more than 15,000 licensed nursing homes in the United States currently make the list. In Florida’s Tampa Bay region, two just did. What the SFF Designation Really Means Aventura at the Bay in St. Petersburg and The Groves Center…
Los Angeles, California — The federal anti-fraud task force led by Vice President JD Vance has suspended 447 hospices and 23 home health agencies in the Los Angeles area over suspected fraud totaling more than $600 million, according to officials familiar with the operation. The number represents a 539% increase from the 70 suspensions reported at the beginning of April, signaling a rapid escalation in the government’s crackdown on what officials describe as one of the largest concentrations of healthcare fraud in the country. “Where there is fraud, the task force will find it,” a spokesperson for Vance said. “We…
Washington, D.C. — Hospitals and health systems across the country are walking away from Medicare Advantage plans in growing numbers, and the federal agency that oversees Medicare just quietly shelved the rule that would have made it easier for seniors to follow them out the door. The New York Times reported this week that nationwide, hospitals and providers are severing ties with private Medicare Advantage plans — citing persistent prior authorization denials, delayed reimbursements, and payment rates that don’t reflect the cost of care. UNC Health, a 20-hospital system in North Carolina, went out of network with Humana, WellCare, and…
Concord, New Hampshire — Nursing home operators across New Hampshire have been losing Medicaid reimbursement money they didn’t know they were owed — and the culprit is a payment formula that no longer reflects reality. The problem stems from a mismatch between two methodologies. The state’s Medicaid reimbursement rate is calculated using a case mix index based on patient complexity measured at a specific point in time. But that figure gets compared against a broader patient population that includes private pay and Medicare residents — not just Medicaid patients. Because earlier data showed higher patient complexity than more recent Medicaid-specific…
Lincoln, Nebraska — Nebraska’s nursing homes just scored a rare unanimous win at the state capitol, and the implications go well beyond the state’s borders. Lawmakers passed LB1091 on April 10 by a vote of 49-0, carving skilled nursing facilities out of Nebraska’s Medicaid managed care program. Under the new law, long-term care services for Medicaid recipients with special needs must now be administered and reimbursed through fee-for-service — not through managed care organizations. Nursing homes can no longer be required to enroll in an MCO as a condition of providing those services. The bill, introduced by Sen. Eliot Bostar…
Washington, D.C. — The Supreme Court is scheduled to hear oral arguments this month in a case that could determine whether hundreds of thousands of Haitian immigrants lose their legal right to live and work in the United States — and senior care providers say the fallout would be felt in nursing home hallways from Boca Raton to Boston. Nursing home operators and advocacy groups have filed an amicus brief asking the court to preserve Temporary Protected Status for Haitians, warning that ending it would deepen an already acute staffing crisis across the long-term care sector. The brief was filed…
Multiple skilled nursing facilities changed hands across the country over the past week, with deals closing in Oklahoma, New York, Iowa, Illinois, Nevada, and Kansas — a sign that transaction activity in the sector remains strong even as operators navigate a choppy economic environment. 506-Bed Oklahoma Portfolio Sold Off-Market A five-building, 506-bed skilled nursing portfolio in Oklahoma was acquired in a direct, off-market transaction brokered by Plains Commercial Real Estate, an Oklahoma City-based firm. The buyer, described as a Northeast-based private equity firm already active in the skilled nursing space, was looking to expand into new states. The seller was…
