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Federal Government Shutdown

What Nursing Homes Need to Know

 

On October 1, 2025, a U.S. federal government shutdown was announced. While the news may create uncertainty across healthcare sectors, nursing home operations are expected to continue with minimal immediate impact. The Centers for Medicare & Medicaid Services (CMS) released QSO-26-01-ALL, outlining how nursing homes will be affected during this period.

Here’s What You Need to Know:

Medicare & Medicaid Payments Will Continue
Medicare and Medicaid payments are considered mandatory spending, so funding for these programs will not stop. Nursing homes should continue receiving payments for services rendered.

Administrative Delays Are Likely
Longer wait times and limited access to agency staff should be expected. Due to staffing reductions at CMS, administrators, providers, and beneficiaries may have delays with:

  • Payment processing
  • Waiver approvals
  • Technical assistance requests

Federal Surveys & Certifications Limited
CMS has announced that only the most serious complaint investigations, those related to actual harm, will move forward. Other oversight activities are paused, including:

  • Routine recertification surveys
  • Inspections tied to less serious complaints\
  • Oversight activities of major CMS contractors

This means nursing homes may experience delays in routine compliance checks.

Independent Dispute Resolutions (IDRs) on Hold
No Independent IDRs will be conducted unless tied directly to a serious complaint that could result in immediate adverse action against a facility during the shutdown.

Exception: Revisit Surveys to Prevent Termination
State Survey Agencies (SAs) may request approval to conduct a revisit survey only if:

  1. A provider has alleged compliance with CMS requirements following a determination of noncompliance, and
  2. The revisit survey is necessary to confirm compliance and prevent scheduled Medicare termination, and
  3. The termination is imminent due to timing or specific circumstances.

Residential Surveys Will Continue
Residential surveys and complaint investigations outside of the federal oversight process will continue, ensuring resident care and safety are still being monitored at the state level.

Bottom Line:

While Medicare and Medicaid funding remains secure, nursing homes should prepare for administrative delays and limited federal oversight during the shutdown. Leaders should stay informed, document all compliance efforts, and prepare for longer turnaround times on requests made to CMS.

For details, read the full memo here: QSO-26-01-ALL.

Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

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Take Action! Reverse Medicare Part B Cuts & Preserve Telehealth Access

If Congress does not take action by March 14th on telehealth and cuts in the Physician Fee Schedule:

  • Telehealth Therapy Services under Medicare Part B WILL END on March 31st.
  • The full -2.83% reduction in the Physician Fee Schedule’s conversion factor will continue in 2025 and impact providers nationwide.

 

Help Reverse Medicare Part B Payment Cuts and Preserve Telehealth Access for Medicare Beneficiaries

On December 21, 2024, Congress passed the American Relief Act, 2025, extending telehealth services until March 31, 2025, but left out provider relief from the 2.83% cut in the Physician Fee Schedule Conversion Factor, which was effective January 1, 2025. Congress also continued government funding until March 14, 2025.  Without further Congressional action by March 14th, rehab therapists will no longer be able to serve their Medicare beneficiaries using telehealth services! It is imperative that Congress hears from their constituents that they must address provider relief and pass a permanent telehealth authority before March 14th! 

If Congress does not take action on telehealth and the cuts in the Physician Fee Schedule by March 14th:

  1. Therapists’ ability to use telehealth to deliver services under Medicare Part B will end on March 31st.
  2. The full -2.83% reduction in the Physician Fee Schedule’s Conversion Factor will continue for the rest of 2025 and impact providers across the country.    

We urge you to contact your Members of Congress NOW to tell them to pass provider relief legislation, such as the Medicare Patient Access and Practice Stabilization Act (H.R. 879) which will mitigate Medicare payment reductions for 2025 and to continue the telehealth authority.

We urge you to contact your Members of Congress NOW! Tell them to pass provider relief legislation to mitigate Medicare payment reductions for 2025 and continue the telehealth authority.

Click here to Take Action now.

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ATTENTION: We need your help to support this bill!

Legislation has been introduced to postpone the 15% reimbursement cuts to PTA and OTA treatments. Please help us to support this bill.

Dear Partners and Friends,

Please take a few minutes to read the below message from NASL regarding the new legislation that has been introduced in the US House. We need everyone to support this bill in order to postpone the 15% reduction in reimbursement for Med B services provided by PTAs and OTAs. This cut is set to happen on 1/1/2022. If this legislation is passed, it will delay this cut until 1/1/2023. Additionally, this bill allows for rural and underserved areas to be exempt from these cuts once they are implemented.

As skilled nursing operators and professionals, I urge each of you to take a few minutes to read the letter, make any additional edits/comments, and submit it to your personal representative. Spending a few minutes of your time could result in a very positive impact for our patients, as well as our industry. Your action is extremely time-sensitive because if this bill does not have enough support, it will not move on.

From NASL: Click here to access the letter and the ability to submit directly to your representative.

The time for advocacy on this issue is now as there is not much time left on the legislative calendar for Congress to act before this policy is implemented on January 1, 2022. NASL has prepared a letter for you to email to your respective House members urging them to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R.5536) and asking them to add the bipartisan legislation to any legislative packages moving before the end of the year.

Use the link above or visit https://app.govpredict.com/gr/m5bwzm-u to access and send this email in under two minutes.

Thank you for your time and effort to support this bill!

Sincerely,

Cassie Murray, President

 

Cassie Murray, OTR, MBA, QCP

President of HTS

Healthcare Therapy Services, Inc.

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2021 Audit Forecast: Cloudy with a Chance of Storms

Blog by: Stacy Baker, OTR/L, RAC-CT, CHC, Proactive Medical Review

Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive documentation, the proper use of SNF waivers, and appropriate access to and accounting for Provider Relief Funds. Get the facts and ensure readiness with these insights into the current audit environment and the medical review entities that may rain on providers in the months ahead. CMS suspended audits between March 30 and August 3 of 2020 in order to reduce provider strain during the COVID-19 pandemic. This year, however, audits are resuming in full swing.

  • Under the new Biden administration, many industry leaders and healthcare attorneys predict an uptick in audits and healthcare prosecutions with “both government initiated litigation and qui tam suits…set for continued growth in 2021” according to Georgia Ravitz et. al (i) With Xavier Becerra, a former prosecutor, appointed secretary of HHS, the government is poised to advance fraud prevention efforts.
  • False Claims Act (FCA) recoveries in FY2020 were $2.2 billion, down from $3.1 billion in 2019 and lower than any year since 2008 at a time when spending has escalated throughout the pandemic. Healthcare made up 85% of FCA recoveries in 2020 and that trend is likely to continue through both standard channels and a focus on new risk areas such as telehealth billing fraud. ii
  • Recovery Audit Contractors are now authorized to review for Medical Necessity and Documentation Requirements specific to the Patient Driven Payment Model (PDPM), and the OIG has added new focus to the Work Plan to identify program integrity risks associated with Medicare telehealth services during the pandemic.

Click here to continue reading this blog.

 

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

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COVID-19 Clinical Tips for Respiratory Assessment

Blog by Sherry Roberts, RN, Clinical Consultant, Proactive Medical Review

COVID-19 is an acute, sometimes severe, respiratory illness caused by a novel coronavirus SARS-CoV2. Person-to-person spread occurs through contact with infected secretions, mainly via contact with large respiratory droplets, but can also occur via contact with a surface contaminated by respiratory droplets. Nursing facilities face higher risk of transmission due to high population density creating difficulty in maintaining avoidance precautions. Significantly, residents of nursing homes are at high risk for more severe disease because of age and underlying medical disorders.

Clinical Presentation

People with COVID-19 may have few to no symptoms, although some become severely ill and die. Symptoms can include fever, cough, and shortness of breath. The exact incubation time is not certain with estimates ranging from 1 to 14 days. The risk of serious disease and death in COVID-19 cases increases with age. COVID-19 can cause Pneumonia and ARDS (Acute Respiratory Distress Syndrome), Severe Acute Respiratory Syndrome (SARS), Acute Respiratory Failure and several other conditions.

Respiratory Assessment

If COVID-19 disease is suspected as part of the screening process, a  thorough respiratory assessment is essential, including careful auscultation to identify residents with a risk of significant lower respiratory illness.

Click here to continue reading this blog.

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We LOVE Celebrating Successful Recoveries!

Southfield Village Therapy Team Celebrates a Successful Recovery!

Patient, Brenda, enjoyed therapy so much that she dressed up for her last day at Southfield Village.

Pictured left to right are Derek Gokee PT, Brenda, and Brian Kemp PTA.

Follow along with our Facebook page to see how we’re helping communities just like yours!

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PDPM Claims Processing Notice Issued by AHCA

Update on CMS & MAC Claims Processing

Below is an update from AHCA on processing of Medicare claims under the Patient-Driven Payment Model. Please note particularly the part that suggests holding claims until Thursday, October 24.

On October 17th, CMS transmitted is quarterly update to all Medicare Administrative Contractors (MACs) as scheduled. CMS also indicated the MACs would need until October 24th to load, test, and launch the update.

Today, we have heard from several members about problems with claims submitted last Friday and yesterday. This likely is because the MACs require more time (e.g., until the targeted October 24th) to finish installation and testing.

Last evening, we informed CMS (both payment policy staff as well as MAC officers about the responses from MACs to-date (e.g., lower likely payments than billed). We will remain in contact with CMS in the coming days.

For now, we recommend holding submission of claims until October 24th – the date CMS indicated the MACs should be ready. On October 25th, COB, we will be in contact with membership about the result of claims submission. If problems persist, AHCA will escalate the issue quickly.

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PBJ Submission Deadline – 11.14.19

The final submission deadline for this quarter is November 14th, 2019. Only data successfully submitted by this time is used on the Nursing Home Compare website and in the five star rating calculations.

Tips:

  • Once information is uploaded, check your Final Validations Report which is accessed in the Certification and Survey Provider Enhanced Reporting (CASPER folder) to verify data was submitted successfully.
  • It may take up to 24 hours to receive the validation report.
  • QIES helpdesk is available for assistance help@qtso.com
  • Do not wait until just a few days before the deadline to submit PBJ data for the reasons above.

Click here to learn more.

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CMS Finalizes $851M Pay Bump for Nursing Homes, Rolls Out PDPM Clarifications

Article by Skilled Nursing News

The federal government on Tuesday finalized a predicted funding increase for nursing homes, while also formalizing changes to several key quality programs — with an eye toward clarifying some parts of the new Medicare payment model for skilled nursing facilities.

Under the terms of the 2020 final rule for Medicare skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) will increase payments to nursing homes by $851 million in the coming fiscal year, which begins October 1 of this year.

That figure represents a slight drop-off from the increase of $887 million projected in the proposed version of the rule, which CMS released back in April; the $851 million comes from a 2.8% increase to the Medicare market basket rate in the final rule, as opposed to a 3% rise in the proposal.

The Tuesday announcement also includes several clarifications related to the Patient-Driven Payment Model, also set to take effect October 1. CMS formally changed the definition of “group therapy” to any modality with two to six residents performing the same or similar activities. That change brings group therapy in SNFs more in line with other care settings, such as inpatient rehabilitation facilities, which use the same definition; CMS currently defines group therapy as activities with exactly four residents.

“As PDPM implementation takes place, CMS believes aligning the group therapy definition serves to improve the agency’s consistency in payment policies across PAC settings,” the agency wrote in a fact sheet about the changes.

Click here to continue reading this article.

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HTS Hosted Site Visit for US Senator

NASL Newsletter Feature: US Senator Mike Braun Visits HTS Therapy Office
On April 24, 2019, U.S. Senator, Mike Braun visited Healthcare Therapy Services (HTS) and one of HTS’ partner facilities in Indiana. NASL members were able to talk with the Senator about the hospital observation stays issue that was NASL’s top issue during the Winter Conference in February. The Senator spent about an hour visiting with staff, as well as interacting with residents.

Thank you NASL for featuring us in your latest newsletter!

Pictured: Senator Mike Braun; his wife, Maureen; Cassie Murray, HTS COO; and Keith Yoder, CEO with Hickory Creek Healthcare Corporation

Pictured: Healthcare Therapy Services representative Shaleen Bhatnagar, Regional Director; Stephen White, Rehab Manager; Cassie Murray, HTS COO; and Steve Chatham, President