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Medicare Reimbursement Reshaped by Wage Index Policy, Impacting Hospitals Differently Across States

Medicare Reimbursement Reshaped by Wage Index Policy, Impacting Hospitals Differently Across States

Medicare reimbursement outcomes for hospitals are increasingly being shaped by wage index policy, particularly the rural floor calculation, rather than solely reflecting local labor market conditions. This policy-driven shift is creating varying reimbursement advantages and pressures across states. Some states are experiencing higher wage index values due to high-wage urban hospitals obtaining rural status, which elevates the statewide rural floor. This results in reimbursement advantages that exceed what local wage growth alone would produce. Conversely, hospitals in other states face increasing pressure, with declining wage index factors despite underlying wage growth, as the wage index operates as a budget-neutral system. This means gains in rural floor benefit states can create offsetting pressure elsewhere. Alaska, Hawaii, the District of Columbia, and certain frontier states (Montana, North Dakota, South Dakota, Wyoming, and Nevada) are less dependent on rural floor dynamics due to unique statutory o...

Rhode Island Medicare Beneficiaries Navigate Complex Coverage Landscape for 2026

Rhode Island Medicare Beneficiaries Navigate Complex Coverage Landscape for 2026

Rhode Island's Medicare landscape for 2026 continues to differentiate between skilled medical care and routine personal care, with Medicare primarily covering the former. Approximately 59% of Medicare beneficiaries in Rhode Island are enrolled in Medicare Advantage plans, while 41% utilize Original Medicare, often supplemented by Medigap policies. Medicare's coverage for home health is specifically for medical recovery, including intermittent skilled nursing, physical therapy, occupational therapy, wound care, and CNA bathing visits, all requiring a doctor's order. However, daily assistance with tasks like bathing, dressing, and meals (custodial care) is not covered by Medicare. For those turning 65, a 7-month enrollment window for Medicare begins three months before their birthday, extends through the birth month, and continues for three months afterward. Medigap Open Enrollment, crucial for purchasing supplemental policies without medical underwriting, starts the month an individual turns 65 and has Medi...

U.S. Senior Living and Skilled Nursing Facilities Adopt Hybrid Financial Models Amid Talent Shortages

U.S. Senior Living and Skilled Nursing Facilities Adopt Hybrid Financial Models Amid Talent Shortages

U.S. senior living and skilled nursing operators are increasingly adopting hybrid financial models to address persistent talent shortages and evolving financial demands. This approach combines internal finance teams with external resources, such as outsourced accounting support or fractional CFO leadership. The shift is driven by the growing complexity of the financial environment in healthcare, which includes navigating diverse reimbursement structures from Medicare, Medicaid, managed care organizations, and private insurance, each with distinct billing and compliance requirements. Additionally, the pipeline of accounting professionals is narrowing, making it difficult and costly for many organizations, especially smaller and regional providers, to maintain fully staffed finance departments with industry-specific knowledge. This hybrid model allows organizations to access specialized expertise, increase capacity, and supplement areas where recruiting and retaining talent has proven challenging, ensuring s...

Cynthia J. Liba Appointed Special Counsel in Corporate Transactions at Cole Schotz in New Jersey

Cynthia J. Liba Appointed Special Counsel in Corporate Transactions at Cole Schotz in New Jersey

Cynthia J. Liba Appointed Special Counsel in Corporate Transactions at Cole Schotz in New Jersey

Humana Expands Healthcare Services and Employment Opportunities Across U.S.

Humana Expands Healthcare Services and Employment Opportunities Across U.S.

Humana Expands Healthcare Services and Employment Opportunities Across U.S.

House Ways and Means Committee Advances Buchanan Bill to Expand Medicare Coverage for Early Alzheimer’s Detection

House Ways and Means Committee Advances Buchanan Bill to Expand Medicare Coverage for Early Alzheimer’s Detection

The House Ways and Means Committee has unanimously advanced the bipartisan Alzheimer’s Screening and Prevention (ASAP) Act (H.R. 6130), co-led by Congressman Vern Buchanan and Congressman Paul Tonko. This legislation aims to provide Medicare coverage for FDA-approved or cleared blood-based biomarker tests for the early detection of Alzheimer’s disease and related dementias. Under current law, Medicare's coverage for preventive services is limited to those specifically authorized by Congress or recommended by the U.S. Preventive Services Task Force, which can cause significant delays in access to new screening technologies. Congressman Buchanan emphasized that early detection is crucial for families to have more time to plan and seek preventative care. The bill is supported by the Alzheimer’s Association and the Alzheimer’s Impact Movement and has garnered 215 bipartisan cosponsors in the House. Companion legislation has also been introduced in the Senate by Senators Susan Collins and Catherine Cortez Masto...

Greenberg Traurig Advises National Healthcare Properties on Multi-State Senior Housing Acquisitions

Greenberg Traurig Advises National Healthcare Properties on Multi-State Senior Housing Acquisitions

Greenberg Traurig Advises National Healthcare Properties on Multi-State Senior Housing Acquisitions

Dartmouth Health Announces Staff Reductions and Program Consolidations Amidst Rising Operating Costs

Dartmouth Health Announces Staff Reductions and Program Consolidations Amidst Rising Operating Costs

Dartmouth Health (DH), New Hampshire’s sole academic health system, has announced significant staff reductions and program consolidations. A total of 124 employee positions have been eliminated, and 303 open positions at Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics Southern Region have been canceled. These changes include the restructuring of executive and administrative leadership roles and the discontinuation of specific programs. The affected programs include Tele-ICU and Tele-ED services, which were deemed unsustainable at their current scale without external support, and the New England Alliance for Health (NEAH), whose necessity diminished as member organizations integrated into larger health systems. Additionally, the Lean Six Sigma Yellow Belt and Green Belt employee training program will be outsourced due to cost-effectiveness. Dartmouth Health attributes these actions to escalating operating expenses, which have grown by 12%, outpacing patient revenues, driven by rising labo...

Marsh Appoints Linda Jones as U.S. Healthcare Industry Practice Leader

Marsh Appoints Linda Jones as U.S. Healthcare Industry Practice Leader

Marsh Appoints Linda Jones as U.S. Healthcare Industry Practice Leader

Trump administration can proceed with homelessness program overhaul, US court rules

Trump administration can proceed with homelessness program overhaul, US court rules

By Nate Raymond BOSTON, Sept 16 (Reuters) - A U.S. appeals court cleared the way on Wednesday for President Donald Trump's administration to reshape a $4 billion homelessness program by shifting funding away from permanent housing assistance toward temporary housing and supportive services.

Medicare Part D Plans Face Increased Financial Risk and Declining Options for Beneficiaries

Medicare Part D Plans Face Increased Financial Risk and Declining Options for Beneficiaries

Medicare's stand-alone prescription drug plans (PDPs) are experiencing significant challenges, including higher premiums and a substantial reduction in available options for beneficiaries. Between 2023 and 2026, the number of PDPs decreased by 55%, from 804 to 360 plans. This decline is partly attributed to the Inflation Reduction Act of 2022 (IRA), which restructured Part D benefits. The IRA increased the generosity of standard benefits, improving affordability for many but also leading to higher drug spending. Additionally, the IRA shifted greater financial liability to Part D plan sponsors, making their benefit costs less predictable. In 2025, Medicare significantly reduced its reinsurance payments to plans while increasing direct-subsidy payments, forcing plans to bear risk on 60% of brand-name drug spending above the out-of-pocket (OOP) cap, compared to 15% previously. This change, coupled with a lowered OOP cap, has created uncertainty for plans regarding future prescription fills and overall costs. ...

Lilly says Foundayo has captured over 30% of new US patients on oral weight-loss drugs

Lilly says Foundayo has captured over 30% of new US patients on oral weight-loss drugs

By Mariam Sunny Sept 14 (Reuters) - Eli Lilly on Monday said it has captured more than 30% of new patients in the U.S. market for oral obesity treatments, narrowing the early lead gained by Danish rival Novo Nordisk with its Wegovy pill.