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Feb 6, 2018

3 Changes to Medicaid Post-Acute & Skilled Care Nursing Facilities Should Know


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The Centers for Medicare and Medicaid Services (CMS) has several changes in store for Medicaid that will affect post-acute care and skilled nursing care facilities in 2018. Familiarizing yourself with these three changes will help your facility make adjustments to ensure that the new rules and policies don’t affect your bottom line.

Waivers May Decrease Medicaid Rolls

CMS Administrator Seema Verma recently announced a change to 1,115 waiver policies that will give states greater flexibility in deciding Medicaid eligibility requirements and scope.


“Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve. We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential,” Verma told attendees at the National Association of Medicaid Directors Fall Conference.

States are considering a variety of proposals to rein in Medicaid costs, including requiring proof of employment, imposing premiums, mandating drug testing, or limiting the amount of time recipients can receive benefits. Currently, proposals are approved for five years and may then be extended for an additional three or five years. Under the new changes, waivers could be approved for as long as 10 years and require less arduous reporting.

These changes to waiver programs would undoubtedly result in leaner Medicaid rolls. If a significant portion of your patients receive Medicaid, you may want to begin making plans now to counter a possible reduction in reimbursements. The changes may happen fairly rapidly, as CMS has pledged to fast-track the approval process.

Scorecards Will Increase Transparency

CMS also announced that it plans to introduce Medicaid and CHIP scorecards in 2018. The scorecards will help ensure that taxpayer dollars are well spent, according to the CMS. Scorecards will track outcomes and spending and will play a role in refining and improving the Medicaid and CHIP programs. Because the scorecards are still being created, details on the metrics that will be included aren’t yet available.

Home Treatment Will Be Encouraged

The CMS has also streamlined the Home and Community Based Service 1915 waiver process, which allows states to develop home- and community-based services for people who have traditionally received long-term care services. According to Medicaid.gov, these services may target specific populations, such as the elderly or people who have traumatic brain injuries, and may include personal care, adult day care, case management, home health aides, respite care, and “services that assist in diverting and/or transitioning individuals from institutional settings into their homes and community.”

The waivers may have an impact on post-acute care and skilled nursing facilities that don’t already offer home-based or community outreach services.

These Medicaid changes are bound to cause a few headaches for post-acute care and skilled nursing facility administrators and staff. Fortunately, it may be possible to overcome or reduce the effects on your facility by developing new strategies and services.

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