The 5.06% capitation rate increase may improve MA plan margins and create greater willingness to negotiate reimbursement rates with skilled nursing providers.
Trump Gives Major Lift to 2026 Medicare Advantage Payments
“Health insurers that sell Medicare Advantage plans are going to get about $30 billion more in taxpayer money next year.”
— STAT, April 7, 2025
How CMS’ Recent Capitation Rate Increase Could Accelerate Value-Based Care, MA in Senior Living
“I think it’s opportunistic for us to take risk and to benefit from our ability as an operator, to improve access to care opportunities, get a return on our efficient care and our quality care and recoup some of the savings that we’re generating.”
— Senior Housing News, May 5, 2025
“I think that trend is going to continue, maybe accelerate, especially when you consider the higher rate that was given to them. Hopefully it’s positive for their market share gain, and it’s going to accelerate the adoption.”
— Senior Housing News, April 10, 2025
[UPDATED]: CMS Rule Fails to Put Restrictions on Medicare Advantage Plans’ AI Use
“CMS is not finalizing certain provisions from the proposed rule at this time. CMS may address these proposals in future rulemaking, as appropriate.”
— Skilled Nursing News, April 4, 2025
Final Medicare Advantage Rule Gives LTC Providers Win but Removes Key AI Protections
“The goal of this provision is to ensure that if a plan approves an inpatient admission, it will have to honor the prior authorization. That is critical for skilled nursing providers, whose Medicare patients require a three-day inpatient stay for Medicare coverage.”
— McKnight’s Long-Term Care News, April 4, 2025
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