The uncertain fate of CMS prior authorization reforms also warrants close monitoring, as their finalization – or abandonment will directly affect denial rates and length-of-stay decisions.
Mid-stream shift: Trump team to weigh unfinished Medicare Advantage coverage rules, program’s future
The Biden administration over the last three years spearheaded efforts to rein in Medicare Advantage plans’ use of prior authorizations to deny care and cut short coverage for nursing homes. But at the end, it also left some pretty substantial decisions on the table for the incoming Trump team — seen by many as pro-Medicare Advantage.
— McKnight’s Long-Term Care News, February 5, 2025
Expanding Medicare Advantage co-pays may leave nursing homes without cash they’ve earned
An increasing number of Medicare Advantage insurers are expected to institute nursing home co-pays starting Jan. 1, a change that could further hit providers already struggling to collect fair reimbursement from the plans. While Medicare charges a co-pay starting on Day 21 of a skilled nursing stay, reports are mounting that many MA plans are adding co-pays starting on the day of admission during 2025.
— McKnight’s Long-Term Care News, December 9, 2024
MA plans shed sickest patients in their final year of life, shifting costs back to government
A new Wall Street Journal analysis has found that private Medicare Advantage plans often shed their sickest patients in the final year of life, shifting the most expensive portion of their care back to the government. Patients in their last year of life, when skilled nursing and other costly care becomes more common, left MA plans at double the rate of other enrollees.
— McKnight’s Long-Term Care News, November 13, 2024
— Source: Wall Street Journal, November 11, 2024 (paywalled)
Election Outcome Could Bring Big Changes to Medicare
The election’s outcome could alter the very nature of the nearly 60-year-old federal program. More than half of Medicare beneficiaries are already enrolled in plans, called Medicare Advantage, run by commercial insurers, and if Trump wins, that proportion is expected to grow — perhaps dramatically.
— KFF Health News, November 4, 2024
It’s UnitedHealth Group’s world — we just live in it
All of this is further evidence that it is easier for CMS to demonize nursing homes than to hold insurers accountable. It also makes it conspicuous how AARP, which has blasted the “shameful” efforts of the underfunded nursing home sector to combat an unfunded staffing mandate, is oh-so-silent about the shameful abuses of its corporate partner, UHG.
— McKnight’s Long-Term Care News, November 4, 2024
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