Skilled Nursing News: ‘Astronomical’ Medicare Advantage Denials, Pre-Auth Issues Cause Outcry from Nursing Homes

The Medicare Advantage preauthorization process and denials of care are a growing concern across the continuum, and nursing home operators and advocates — as well as federal lawmakers — are pushing more urgently for change.

Such concerns are not new, and already some action has been taken: the Centers for Medicare & Medicaid Services (CMS) has sought to stop diversions of patients away from skilled nursing facilities while ensuring more consistency between MA and traditional Medicare.

Nevertheless, these forthcoming changes haven’t eased the headaches faced by nursing homes nor allayed fears by advocacy groups. And legislative efforts to reign in MA plans need to be stronger, nursing home operators and advocates say.

“Insurance providers won’t pay for patients to stay because, per their guidelines, they were well enough to go home … it is just astronomical, the amount of patients that are discharged too early because the insurances will no longer pay,” said Laray Fayad, Regional Director of Care Connect and Census Development at Texas-based Focused Post Acute Care Partners (FPACP), which operates 27 nursing homes.

In the end, the burdens of cost and care are shifted to providers of health care across the continuum, Fayad told Skilled Nursing News, and quality gets compromised while rehospitalizations go up.

Click Here to Read the Full Article Written by Zahida Siddiqi at SkilledNursingNews.Com!

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McKnights: Return of 3-day stay, loss of nurse aides bearing down on nursing homes with PHE’s end

Providers whose patients are cut from Medicaid could turn to billing family members, but such relatives aren’t necessarily under any obligation to pay for their relatives’ care.

And then there are the states that have tied additional Medicaid funding to the PHE itself. In Texas, for instance, the state’s pick up of a $19 a day COVID bump is scheduled to end later this month.

The state did not increase rates during COVID and anything passed this legislative session won’t go into effect until September.

“If we lose PHE funding in May and are not made whole until September, that’s three-and-a half months when we are asked to balance caring for our most vulnerable seniors, paying our dedicated staff — and in the midst of the nation’s worst nursing shortage — recruiting and retaining qualified nurses,” said Samantha Milstead, executive director of operations for Focused Care at Midland, a skilled nursing community located in rural West Texas.

“If the federal government has decided the emergency is over, and our state legislators have recognized long-term care delivered well, with the goal of improving health outcomes and quality of life requires increased funding,  then they must acknowledge we need a safety net to keep us from plummeting into the gap,” Milstead told McKnight’s. “Abandoning long-term care providers is abandoning the residents we care for.”

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Holderread: Don’t leave behind our rural seniors

People who work in skilled nursing facilities do more than provide care to vulnerable seniors.

While the “caring” part of our job is primary, there are countless things we do that aren’t a part of the everyday patient-centered care plan tailored to each resident. Yet, they fall under the category of “caring.”

They aren’t coded specifically for Medicare or Medicaid reimbursement — they are a part of the mission we all sign on to when we work in skilled nursing care.

For example, we build relationships with the family members of our residents to ensure their trust in us and make certain they know the door to communication never closes. Providing comfort and instilling confidence that we are caring for their loved one as they would is as important to us as it is to our families. We remember and celebrate special holidays, partner with the community to engage in fun activities, initiate donation drives for others in need and honor the hard work and compassion of fellow team members.

We also are the voice for those who may feel theirs is lost or not heard. We are the advocates for our residents, family members, fellow care providers and the profession overall. Part of our job is to call for smart, logical public policy that supports our ability to continue our mission.

Read Full Article Here in the Longview News-Journal.

Rebecca Holderread is the Executive Director of Operations for Focused Care at Gilmer.

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McKnights: As goes Texas?

For nearly a year and half, Texas nursing home operators have been waiting for the moment before them: the early days of the most promising legislative session in nearly a decade.

What happens to Medicaid rates there between now and the end of May, when lawmakers will leave Austin until 2025, could either save or sink skilled nursing providers. But what happens in Texas surely won’t stay in Texas.

Big expectations for a long-awaited and significant increase in the state’s daily reimbursement rate also have been driving excitement among major owners and investment companies.

The big guys like Sabra and Ensign are all-but banking on better days in the Lone Star State, even as the nation faces continued talk of possible recession. If lawmakers don’t hit the targets these major players have set internally, we could see resources pulled from Texas and diverted to more provider-friendly states.

And if Texas denies providers a substantial rate increase, they likely won’t be the only ones. Already, providers in New York, New Hampshire and other states are crusading for rates that more accurately reflect the cost of the work they do — and new operating expectations that are very likely coming, and coming soon.

Of course, there are plenty of small and mid-size Texas operators whose fates ride on this session, too.

Mark McKenize, founder of Focused Post-Acute Partners, tells me he is “laser focused” on securing the Medicaid rate increase this year, for budget years 2024 and 2025.

“In terms of time, investment and local access to public officials who have the power to improve the skilled nursing care sector in Texas, this is where I have to focus my energy,” he said last week, noting the uphill battle for understanding and support even in the face of COVID and, now, historic labor shortages.

Read Full Article Here at McKnights.Com

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