Washington, D.C. — The federal agency that oversees nursing home regulations says it’s done treating administrative complexity as a given — and it wants skilled nursing providers to hold it to that.
At a Burden Reduction Conference on Wednesday, Centers for Medicare & Medicaid Services leaders made unusually candid admissions about how red tape is pushing trained caregivers out of the field. CMS Administrator Dr. Mehmet Oz set the tone early.
“Most people leave the field not because of the pay or any other factor other than the reality that the hassle factor is so large that this stops being fun,” Oz said. “It’s the relationship with the clinician and the patient that we’re interfering most with when we impose those rules.”
Prior Authorization, Reporting Burdens in the Crosshairs
Kim Brandt, the agency’s deputy administrator and chief operating officer, called out pain points that skilled nursing operators know well: prior authorizations, duplicative quality reporting, and repetitive documentation requirements.
“For too long, administrative complexity has been treated as an unavoidable part of public programs,” Brandt said. “Complexity is not inevitable. Red tape is not sacred.”
Brandt said CMS is working to make prior authorizations faster and more transparent. Oz cited a voluntary initiative with insurers — launched last year — aimed at getting 80% of prior authorization requests reviewed “almost instantaneously” by year’s end. The agency is also piloting AI-assisted prior authorization in traditional Medicare across six states, which has drawn concern from operators who say insurers already overuse automated denials.
Long-Term Care Still Left Out
A recurring frustration at the conference: nursing homes keep getting bypassed when federal tech investments land. Speakers pointed to the 2009 Meaningful Use program as a prime example — it handed out EHR incentive payments but largely skipped post-acute settings. Many skilled nursing facilities still lag hospitals significantly in health IT adoption.
Nicole Fallon of LeadingAge pushed for a structural fix. Payment models, she argued, need to reward nursing homes alongside hospitals and physicians — not cut them out of shared savings arrangements.
“Part of the reason we get shared savings out of those models is because we’re limiting care, like skilled nursing care, because it’s a per diem,” Fallon said. “So for every day of care I don’t deliver, it’s a savings that goes somewhere else.”
A New Model Coming
CMS is moving ahead with the Long-term Enhanced ACO Design — LEAD — model, slated for a 2027 launch. The program is built to include smaller and independent providers, particularly those in rural and underserved areas, and give them access to value-based care arrangements they’ve largely been shut out of.
For a sector used to seeing its regulatory burden grow year over year, Wednesday’s conference offered a different message. Whether it leads to actual relief remains to be seen — but for operators and advocates, it was at least a reason to pay attention.
