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Tags Posts tagged with "Nursing Facility"

Nursing Facility

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NOTE TO INSPECTOR: The word "iridium" on the pen's nib is not a brand: it's the name of the metal of which the nib is made. Thanks. Inky old fountain pen on a $100 bill.

The Medicare Payment Advisory Commission (MedPAC) held their regular public meeting on January 16 – 17, 2025. During one of their presentations, “Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services; Home Health Agency Services; Inpatient Rehabilitation Facility Services; Outpatient Dialysis Services; and Hospice Services,” there was a draft recommendation specific to inpatient rehabilitation facilities (IRF). The draft recommendation was for fiscal year 2026 and noted that Congress should reduce the 2025 Medicare base payment rate by 7 percent. The PowerPoint presentation is available here.

During this public meeting, MedPAC voted to finalize this recommended payment reduction to fiscal year 2026 IRF Prospective Payment System (PPS) payments. Both AMRPA and other national hospital stakeholders, on behalf of IRFs, strongly opposed this proposed payment cut (prior to the public meeting). However, MedPAC advanced the recommended cut with limited discussion about the potential impacts on patient access and IRF operations.

MedPAC’s recommendations do require Congressional action. As a result, advocacy will be planned to continue to voice concerns with this recommendation. Members will be kept apprised of any upcoming changes.

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The Centers for Medicare & Medicaid Services (CMS) has made updates to the training schedule for Home and Community-Based Services (HCBS) provisions of the Medicaid Access Rule. The new training session dates and tentative topics for each session can be found below. These dates and topics are subject to change.

  • May 14, 2025, 3:00 pm ET: Timely Access, Waiting Lists, Person-Centered Planning Reporting Requirements & Minimum Performance Levels, and Website Requirements
  • June 11, 2025, 3:00 pm ET: Institutional Rule Provisions*

*Nursing Facility and Intermediate Care Facilities for Individuals with Intellectual Disabilities Rate Transparency provisions finalized in CMS-3442-F: Medicare and Medicaid

You can learn more about the training series and register for upcoming sessions on the HCBS Provisions of the Medicaid Access Rule Training Series registration web page.

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ODP Announcement 22-039 describes actions the Administrative Entities (AE) and Supports Coordination Organizations (SCO) must take when an Office of Developmental Programs’ (ODP) waiver or base participant is admitted to a nursing facility in order to ensure a coordinated transition to Long-Term Care (LTC) services and prevent service interruptions. Read the full announcement for details.

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ODP Announcement 22-039 describes actions the Administrative Entities (AEs) and Supports Coordination Organizations (SCOs) must take when an Office of Developmental Programs’ (ODP) waiver or base participant is admitted to a Nursing Facility (NF) to ensure a coordinated transition to Long-Term Care (LTC) services and prevent service interruptions.

When an ODP waiver participant (Adult Autism, Consolidated, Community Living, or Person/Family Directed Support) is identified for NF admission, he or she will transition from the ODP waiver to Community Health Choices (CHC) for their Long-Term Services and Supports (LTSS). Nursing services are started the day of admission into the NF, ensuring health and safety. The individual must begin to receive CHC services on the day he or she is admitted to the NF. Individuals cannot be dually enrolled in CHC and an ODP waiver. The AE, county MH/ID program, and/or SC will assist the individual in transitioning to the NF and move the participant into reserved capacity for their ODP waiver.

Enrollment in an ODP waiver or base services in HCSIS prevents the CHC from enrolling the individual in LTSS in eCIS; therefore, the AE must end date the waiver or base enrollment in HCSIS prior to the CHC enrollment date in eCIS/CIS to avoid overlap.

Please review the announcement for further guidance.

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