Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
Updated Fri 12:06 PM MT
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Skilled Nursing News

3 stories

Federal Policy·3d ago

CMS Updates MDS Coding Guidance, Discharge Rules Still Unclear

CMS has issued updates to the MDS 3.0 Resident Assessment Instrument manual that address a long-standing provider concern: documentation demands during state case-mix audits and medical reviews that are often additional or conflicting. Nursing home operators and industry observers describe the coding changes as a significant win for providers, though questions remain around discharge coding clarity. The updates are due to be implemented, though the source does not specify a firm effective date. Nursing facilities, Medicaid case-mix states, and auditors handling MDS-based reviews will need to adjust documentation and audit practices once the guidance takes effect.

Industry·MA·3d ago

Out-of-State Chains' Nursing Home Buyouts Tied to Quality Declines in Mass.

Citing a Boston Globe Spotlight investigation, Skilled Nursing News reports that out-of-state chains have rapidly acquired Massachusetts nursing homes since 2020, with nine New York and New Jersey-based chains growing their holdings from 12 facilities in 2019 to 61 by 2025, about one-fifth of the state's nursing homes. Eight of the nine chains saw average federal star ratings decline after acquisition, driven by cost-cutting that slashed nursing hours while shifting payments to owner-affiliated companies. RegalCare, led by CEO Eli Mirlis, is highlighted as a case study: facilities fell from 5-star to 1-star ratings within three years as rent and related-party payments rose even as nursing spending fell. The Globe found Massachusetts regulators have not denied an acquisition application or revoked a license in seven years, though a recent law now lets them weigh an operator's out-of-state record.

Legal·MA·3d ago

RegalCare Nursing Home Execs Pay $1M Over Billing Claims

Massachusetts nursing home operator RegalCare Management Group, along with owner Eliyahu Mirlis and executive Hector Caraballo, agreed to pay $1 million to resolve allegations that they submitted false claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy. Federal prosecutors said the conduct occurred between 2018 and 2023. The settlement resolves the billing allegations against the company and the two named executives.

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