Although focused on Medicaid, the report’s insights into the prevalence of denials, common reasons for disputes, and variations across state programs are valuable for facilities reliant on Medicaid reimbursement. By understanding these trends, skilled nursing facilities can strengthen documentation practices, proactively address potential red flags during utilization review, and develop effective appeal strategies to minimize payment disruptions and ensure access to care for Medicaid beneficiaries.
MedPAC also highlighted institutional special needs plans (I-SNPs) for nursing home residents, highlighting their potential for improved care coordination despite limitations in data and access. The report also touches on issues such as rural provider quality measurement and beneficiary cost sharing.
June 2025 Report to the Congress: Medicare and the Health Care Delivery System – MEDPAC. (n.d.). https://www.medpac.gov/document/june-2025-report-to-the-congress-medicare-and-the-health-care-delivery-system/
Stulick, A., (2025, June 16). MedPAC urges reform of Medicare advantage, noting ‘Design flaws’ in nursing home payment models. Skilled Nursing News. https://skillednursingnews.com/2025/06/medpac-urges-reform-of-medicare-advantage-noting-design-flaws-in-nursing-home-payment-models/
Achal, R. (n.d.). New MedPAC report highlights nursing home and I-SNP trends. https://www.ahcancal.org/News-and-Communications/Blog/Pages/New-MedPAC-Report-Highlights-Nursing-Home-and-I-SNP-Trends.aspx
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