Four additional CMS skilled nursing facility value-based purchasing (SNF VBP) measures take effect October 1, 2024 that will determine Medicare Part A rates beginning October 1, 2026. These measures are in addition to the four measures already in place that impact rates starting on October 1, 2025

Administrators, DONs, finance, QAPI, and operations leaders should be familiar with the eight measures and understand how they impact future reimbursement rates. SNF VBP Essentials is a one-hour course that details the new CMS measures and discusses how CMS calculates VBP measures, risk adjustment, facility score and payment adjustments. The course provides instructions on using a SNF VBP prediction calculator tool (included with the course) that helps estimate the financial impact the measures will have on a nursing facility’s Medicare Part A revenue.

The training delves into all eight measures which are:

• Hospital Readmissions
• Healthcare Acquired Infection Hospitalizations
• Long-stay Hospitalizations
• Discharge to Community
• Discharge Function Score
• Total Nurse Turnover
• Total Nurse Hours Per Resident Day
• Long-stay Falls with Major Injury

Understanding all eight measures and adopting best practices now will help avoid Part A payment penalties and potentially boost future incentive payments. 

Presenter: Kiran Sreenivas, Vice President, Research, Integrated Networks & Research, AHCA

Cost: $40 AHCA Members | $80 Non-Members

1.25 NAB CEs and 1.0 contact hour through the Iowa Board of Nursing are available upon course completion.

© 2024 American Health Care Association. All rights reserved. 

All SNF VBP Essentials materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Since March 2020, States ceased Medicaid eligibility determinations and have been unable to disenroll any Medicaid beneficiaries from the Medicaid program.  The freeze on redeterminations and prohibition on disenrollment were based upon federal statutory requirements States had to meet to receive the increased federal Medicaid funding of 6.2% over the course of the pandemic.  Now, with the Public Health Emergency (PHE) ending, States are returning to “regular” Medicaid redeterminations schedules. 

Why This Matters

• States – State Medicaid Agencies have over 87 million redeterminations to conduct before May 2024.  Most states have not conducted redeterminations in over three years.  Over that period, beneficiary information has become out of date (contact information, financial information, etc.) and State Agencies have had significant staff turn over and shortages.  In many States, their State and/or County eligibility units may have few or no staff with redetermination expertise.  Despite CMS guidance and support, this could result in notable breaks in Medicaid coverage; and
• Providers – If a beneficiary loses Medicaid eligibility, Medicaid payments stop, and beneficiaries have very clear protections in federal law for when these breaks occur despite the loss of Medicaid payments.  Additionally, while at first glance waves of nursing facility (NF) and assisted living (AL) Medicaid redeterminations may seem of little concern, it is probable that the following are problematic: a) staff turnover in NF and AL business offices resulting in little to no Medicaid redetermination experience; and b) while older adult and persons with disabilities functional criteria to meet Medicaid Levels of Care are highly unlikely to change, the people involved with managing their finances likely have changed. 

For a more in depth discussion of Medicaid Unwinding, click here.

AHCA/NCAL Resources

The Association has prepared an array of resources aimed at supporting NFs and ALs to manage significant numbers of Medicaid Redeterminations.  Working with partner organizations, AHCA/NCAL has developed three modules and related tools. 

Disclaimer – Of note, these materials do not constitute business or legal guidance.  They are for general education and planning efforts, only.  For in depth support, please contact your information technology contractor, third party consultants or attorneys.

Course Outline:

• Module 1:  Medicaid Unwinding – Provider Action Steps and Tools
• Module 2: Financial Care Plan Development and Management
• Module 3:  Medicaid Application Development and Submission

This course is free to AHCA/NCAL members only. 

Follow the instructions below to register. 

• To avoid technical problems, use Google Chrome. 
• Members will need to log in using their existing email and password first. 
• Once you are logged in to the website you will be able to register by clicking the green register button at the top of the page. 
• If you have forgotten your password click here. 
• If you are new to the site, you can create an account here. Answer all fields on the create an account page- especially locating your company name. You can search by name or zip code. After creating an account, you will be able to register. 

Need further assistance? Email educate@ahca.org

A certificate of completion will be available upon completion. There are no CEs available for this training. 

© 2023 American Health Care Association. All rights reserved. 

All Medicaid Unwinding – Return to Regular Medicaid Redetermination: Ensuring Resident Medicaid Coverage materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

This first recording provides expert insights from Certified Public Accountants (CPA) who consult with many of our members. The 90-minute webinar overs a road map and tips on: a) revenue management and opportunities; b) expense management strategies; and c) compliance strategies to mitigate recoveries. Also available are three model checklists associated with each of the three sections noted above. The webinar also provides guidance on how to tailor these three template checklists to your needs. 

© 2022 American Health Care Association. All rights reserved. 

All Independent Owner In-Focus Series: Maximizing Cash Flow and Enhancing Net Income materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

AHCA/NCAL now has available a pre-recorded webex on the January 15, 2021 PRF Reporting Registration instructions as well as the updated reporting guidance.  The video recording includes:   

• Detail on registration 
• Important registration FAQs 
• Recommended Terms and Conditions Compliance Controls 
• PRF Reporting Update Overview  

AHCA /NCAL will provide updates to this information as HHS provides additional detail.   

This webinar is available to AHCA/NCAL members only. 

How to Register: 

• To avoid technical problems, use Google Chrome. 
• Members will need to log in using their existing AHCA/NCAL username and password first. 
• Once you are logged in to the website you will be able to register by clicking the green register button at the top of the page. 
• If you have forgotten your password click here. 
• If you are new to the site, you can create an account here. Answer all fields on the create an account page- especially locating your company name. You can search by name or zip code. After creating an account, you will be able to register for the webinar. 

Need further assistance? Email educate@ahca.org

© 2022 American Health Care Association. All rights reserved. 

All PRF Reporting Requirements – Updated January 25th materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.