Medicaid Managed Care Rule Changes

In November of this year, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to Medicaid managed care regulations that had been proposed two years prior.

Changes include updates to network adequacy standards, beneficiary protections, rates and payment.

For more on this, see the article below.

MA Capitation Rates Rising In 2022

An increase in capitated rates may prove positive for Medicare Advantage (MA) payers like Humana, UnitedHealthcare, Aetna and Anthem in 2022. To combat improper inflation of risk scores, the Centers for Medicare and Medicaid Services (CMS) is proposing to rely on encounter data to calculate patient risk.

For more on this, please see the article below.

I-SNPs Show Promise Even During Pandemic

An institutional special needs plan (I-SNP) is essentially where a nursing home becomes a Medicare Advantage (MA) provider. Many who are venturing into this process started last year. COVID-19, however, has delivered major challenges.

The article below details clinical upsides being discovered as well as a view of how timetables are currently adjusting.

Providers Who Perform Well Under PDPM

Under the new Patient-Driven Payment Model (PDPM), Medicare rates are determined by a formula that captures how providers measure on five care components.

Those that are performing well under PDPM are effectively capturing key payment drivers and not leaving money on the table.

For more on this, please see the article below.

Three-Day Rule To Return After The Pandemic

Post- pandemic rules for nursing home care may look different than before or even during the crisis.
Though some changes made during the health emergency, telemedicine restrictions, for example, being loosened may remain, others like the three-day stay requirement may not.

For more on this, please see the article below.

New Rules For COVID-19 Testing In Nursing Homes

Seema Verma, Centers for Medicare & Medicaid Services (CMS) Administrator, recently opened up about nursing home testing for COVID-19, noting testing should be routine.
New rules presented last month require facilities to test with a specific frequency depending on the spread in the surrounding county.

For frequency specificity and more on this, please see the article below.

SNF Occupancy Stabilizing?

With skilled nursing occupancy down-trending since 2015, the pandemic made things much more difficult for facilities.

In June this year, however, Managed Medicare increased, resulting in what appear to be stabilizing revenue streams.

For more on this, please see the article below.