Facilities should monitor whether CMS’s stated MA crackdown translates into enforceable policy and explore opportunities for risk-based partnerships before regulatory and funding conditions shift further.
‘Long-Term Harm’: Former CMS Chief Warns HHS Cuts Will Impact Nursing Home Surveys, MA Oversight
Former CMS Director Chiquita Brooks-LaSure warned that planned reductions to the HHS workforce – from 82,000 to 62,000 full-time employees – would directly impact nursing home survey operations and Medicare Advantage oversight. She cautioned that the administration’s claims of no program impact were “extremely dubious,” and added: “If you’re going to ask the agency to do more…you have to make sure that you’re sufficiently providing the resources.”
— Skilled Nursing News, April 1, 2025
New CMS Innovation Center Strategy Holds Promise for Senior Living Value-Based Care, MA Plans
“We have four years under our belt taking risk for those who are on our campus communities. What CMMI is trying to do now is saying, let’s expand that value proposition and take it off campus, create choice and lean on evidence-based outcomes that providers have generated, and bring that into the general community.”
— Senior Housing News, May 13, 2025
CMS Explores Limiting Insurers’ Use of Prior Authorizations
“Leaders at the Centers for Medicare and Medicaid Services are exploring proposals to limit health insurers’ use of tactics that can delay medical care, people familiar with the discussions said.”
— Modern Healthcare, April 29, 2025
At his Senate Finance Committee confirmation hearing, Dr. Mehmet Oz signaled a break from his prior support of Medicare Advantage plans and acknowledged systemic fraud in MA diagnosis coding. On administrative efficiency, he stated: “We spent about 12% of the CMS budget on bureaucratic processes…I believe we have the power right now, with technology that didn’t exist from three or four years ago, to automate a lot of these processes.”
— Skilled Nursing News, March 14, 2025
Dr. Oz Pledges Medicare Advantage Scrutiny: ‘There Is a New Sheriff in Town’
“Part of this is just recognizing there is a new sheriff in town. We actually have to go after places and areas where we’re not managing the American people’s money well.”
— STAT News, March 14, 2025
Will the Trump Administration Fast Track the Privatization of Medicare?
The federal government currently “pays insurers 20% more for Medicare Advantage enrollees than it pays for similar people in traditional Medicare, at a cost of $84 billion in 2025.” The analysis further notes that this overpayment “results in $13 billion in higher Medicare Part B premiums paid by Medicare beneficiaries, including those who are not in Medicare Advantage.”
— KFF, March 13, 2025
Providers and Advocates Urge House to Take Post-Acute Care Off the ‘Chopping Block’
AHCA President and CEO Clif Porter testified that “skilled nursing facilities play a pivotal role in meeting these needs, and there are key areas where access can be improved, such as enhancing care coordination, strengthening Medicare Advantage, tackling workforce shortages, and preventing cuts to Medicaid.” Advocate Eric Carlson of Justice in Aging added: “For many older Americans, post-acute care is not a matter of weeks or months, [especially] when they have ongoing chronic conditions [such as] Alzheimer’s disease that requires daily, hands-on assistance.”
— McKnight’s Long-Term Care News, March 12, 2025
Medicare Advantage, Medicaid Cuts Deemed Devastating for Nursing Homes at House Hearing
During a House Ways and Means Committee hearing, Madonna Rehabilitation Hospitals CEO Paul Dongilli noted the scale of MA denial reversals: “Roughly, maybe 40% of the ones that are initially denied are overturned during an appeal.” Justice in Aging’s Eric Carlson warned of the downstream effect on providers: “It falls on the facilities that already aren’t adequately reimbursed…they will be squeezed out of the system.”
— Skilled Nursing News, March 11, 2025
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
