Healthcare, Senior Living, Economics
Information and discussion on general federal health policy and politics – including Medicare, Health Reform and all other subjects Fed.
When the 2025 Final SNF PPS Rule was released, the focus was on Medicare rate increases. This is typically known as the “headline”. But as readers and followers here know, there is always a regulatory tidbit or two that can be even more significant in terms of operations, particularly as more and more Medicare patient … Read more
As anticipated, litigation has started via various sources, in Federal courts, challenging CMS’ SNF “staffing mandate”. For specifics on the mandate and actual text, go here: https://rhislop3.com/2024/04/23/cms-final-snf-staffing-rule/ A big impetus behind the legal challenges to CMS mandate is the recent Supreme Court ruling known as the Chevron decision https://rhislop3.com/2024/07/01/scotus-chevron-decision-a-win-for-healthcare/ The decision overturns a longstanding doctrine … Read more
On September 30, US District Judge Kathryn Kimball Mizelle from the Middle District of Florida ruled in a landmark decision that the qui tam provision of the federal False Claims Act (FCA) is unconstitutional. This ruling could have significant impact on whistleblower (Qui Tam) actions filed against healthcare providers, particularly home health and hospice (most … Read more
Here’s an oldie but a goodie for today. The House Ways and Means Committee is reportedly considering a markup of legislation this month that would revamp Medicare’s physician payment system. This move could increase the likelihood of incorporating a “doc fix” into a lame duck legislative package. Historic readers and followers of Reg’s Blog will … Read more
With increasing older adult demand for hospital care, an ongoing wave of nursing home closures is creating post-acute access issues. Since 2020, 774 nursing homes have closed, and only seven new facilities opened in 2024. The primary driver for closure is a nationwide shortage of qualified clinical staff, exacerbated by the COVID pandemic. The pandemic … Read more
The U.S. spends more than any other world nation on healthcare – gross dollars and per capita. The systemic growth of spending continues at rate beyond inflation, spurred-on by an aging demographic and chronic diseases like diabetes and obesity. Cost growth in programs like Medicare is rampant but then again, so is fraud. Federal spending … Read more
A number of weeks back I looked at what was known and could be divined about Kamala Harris’ health policy. Today, with the election getting close (less than 70 days out), it’s an opportune time to look at Donald Trump’s likely health policy positions. The Harris post is available here: https://rhislop3.com/2024/07/23/kamala-harris-likely-health-policy/ Both candidates have shared … Read more
According to a Wall Street Journal article from August 4, Medicare Advantage plans are using home nurse visits to identify possible or questionable disease states/conditions (so called, phantom diseases) via screenings. These diagnoses then turn into what appears to be, possible events of fraud via additional reimbursement tied to these new-found conditions. Exclusive | The … Read more
Under the Final 2025 (PPS) rule released last Wednesday, nursing homes are set to receive a 4.2% pay increase in Medicare Part A. Additionally, the facilities will encounter a stricter fines system, with civil monetary penalties being applicable in more situations. The Final Rule is available here: SNF Final Rule 2025 In April I wrote … Read more
Not too long ago, I wrote a post regarding federal legislative activity seeking to impose regulation on Private Equity firms investing in senior living organizations (SNFs, home health, hospice, assisted living). That post is available here: https://rhislop3.com/2024/06/13/private-equity-investment-in-nursing-home-sector-generates-regulatory-scrutiny/ That post focused on a bill known as the Corporate Crimes Against Health Care Act of 2024 aims … Read more