‘A Band Aid on a Gaping Wound’: CMS’ $20M Incentive for RNs in Nursing Homes Leaves Much to be Desired
The Centers for Medicare and Medicaid Services (CMS) plans to offer up to $20 million to boost the registered nurse (RN) workforce in nursing homes, but this, along with the agency’s Nursing Home Staffing Campaign, misses the mark on many levels, according to operators.
This funding grants nursing students seeking to become RNs up to $50,000. Of that amount, a maximum of $40,000 can go towards tuition reimbursement. Also, the nursing students have to commit to work for a qualifying nursing home or state survey agency for a period of three years.
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"Medicare Advantage is no advantage,"
U.S. Senator Richard Blumenthal (D-CT) on the release of a new Senate report (click here) showing MA plans have been systematically denying and delaying care. Blumenthal chairs the Senate's Permanent Subcommittee on Investigations that conducted the research. As you can imagine, the MA PR machine has been working around the clock to push back, saying the report is a "mischaracterization" and "misleading". The probe was more than a year in the making by the Permanent Subcommittee on Investigations and was released by only Democratic senators. Click here for the committee's press release. Click here for an excellent STAT article on the report. Among the findings:
In 2022, United Healthcare and CVS denied prior authorization requests for post-acute care at rates three times higher than the companies' denial rates for all types of prior auth requests.
Humana denied prior auth requests for post-acute care at a rate 16 times higher than its overall denial rate.
UHC's prior auth rate for post-acute care jumped from 10.9% in 2020 to 22.7% in 2022.
At least 28 health systems will no longer be under contract with MA plans this year. Mostly citing the increasing prior authorization requirements and denials of care to their patients, systems in several states are ending contracts with Humana, Aetna, Blue Cross Blue Shield, and UnitedHealth. To see the full list in Becker's, click here.
MA participation has nearly doubled in the past decade and 40 percent of Medicare beneficiaries in rural areas are in an MA plan, according to a new report released by Better Medicare Alliance - a group funded largely by insurers - click here.
CMS: MA Plans Expected to Get 4.3% Pay Bump
CMS released the Calendar Year (CY) 2026 Advance Notice for the Medicare Advantage and the Medicare Part D Prescription Drug Programs that would update payment policies for these programs. Payments from the government to MA plans are expected to increase on average by 4.33%, or over $21 billion, from 2025 to 2026, as proposed. CMS proposes to complete its implementation of a three-year phase-in of improvements to the MA risk adjustment model and growth rate calculation related to medical education costs as described in the CY 2024 Rate Announcement, as well as other technical improvements. Click here for a CMS summary and the rule.
· As providers continue to highlight the difficulty with Medicare Advantage prior authorization requirements, many are reviewing the rules that were finalized last year to "improve the electronic exchange of health information and prior authorization processes for medical items and services," according to a CMS press release. Many providers say the rules do not go far enough and can be limiting in scope. Click here for details.
· As of January 4, 2025, 23.6 million consumers had selected a plan for coverage in 2025 since the start of the Marketplace Open Enrollment Period (OEP). Over 20.4 million consumers had active 2024 coverage and selected a plan for 2025 coverage or were automatically re-enrolled. Click here for state-by-state details.
It took about 10 years, but BCBSA agreed to a multi-billion settlement last week.
The Blue Cross Blue Shield Association – representing the Blues across the country – agreed last week to the largest settlement in U.S. antitrust health care history. The Association and 33 of its member companies will pay $2.8 billion to settle the allegations that they suppressed competition and underpaid providers for reimbursements between July 2008 and October this year. Additionally, under the terms of the settlement, the Blues will offer providers expanded options for coverage, over 500 hospitals may be able to negotiate new contracts.
For the announcement from the law firm representing the plaintiffs, click here, for the memo on the settlement, click here, and for the settlement agreement itself, click here.
UnitedHealth Group Reports Strong Earnings but Stock Drops Amid Cautious Outlook
UnitedHealth Group saw its stock fall nearly 8 percent following the release of its third-quarter earnings report, which revealed a profit of $6.06 billion – up from $5.8 billion a year earlier – but expressed a cautious outlook that disappointed investors. Despite exceeding Wall Street expectations in both earnings and revenue, with total revenue reaching $100.8 billion, the company highlighted ongoing challenges in the Medicare Advantage and Medicaid sectors, which are expected to persist into 2025. Executives noted the impact of regulatory changes and the unwinding of Medicaid programs, while emphasizing the importance of long-term planning in navigating pricing pressures. Click here to read UnitedHealth Group's press release.
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Experts Worry the Immigration Crackdown Will Impact Long-Term Care Aides
Long-term care relies on home health aides, personal care aides and certified nursing assistants as a critical component of their workforce. Now many in the industry are worried how the immigration policies of the incoming Administration will impact their workforce. The long-term care industry is already dealing with a significant shortages and some of the suggested "crackdowns" on immigration could worsen the growing problem, as about 27 percent of direct care workers are immigrants. Roll Call reviews the proposed policies and the impact on the long-term care industry, click here.
HHS Releases AI Strategic Plan
HHS has released the Artificial Intelligence Strategic Plan to establish the strategic framework and operational roadmap for leveraging emerging technologies. The plan sets out development of policy and regulations, allocation of resources, ways to conduct outreach and education programs, and cultivation of the workforce related to AI. Click here for the plan, and here for the HHS press release.
More Practices Screening for Social Risks
A cross-sectional study that examines trends in social risk screening among US physician practices from 2017 to 2022 found that the proportion of practices systematically screening for five common social risks (food, housing, utilities, interpersonal violence, and transportation) increased significantly, from 15% in 2017 to 27% in 2022. Released in JAMA Network, the analysis, based on the National Survey of Healthcare Organizations and Systems, shows that screening is "still vastly underperformed," as fewer than one-third of practices screened for all five risks in 2022. Additionally, there is a lack of data on whether this screening is actually associated with improved health outcomes, which points to a need for further research to evaluate how these screenings translate into improved patient outcomes through healthcare adjustments or social needs referrals. To view the full report, click here.
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