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San Francisco Chronicle
19 hours ago
- Health
- San Francisco Chronicle
Bid by S.F.'s largest nursing home to restore 120 beds rejected by federal regulators
San Francisco's largest skilled nursing home, Laguna Honda, will not be able to reinstate 120 beds — which would have improved capacity for such care in the rapidly aging city — after federal regulators this month denied the hospital's attempt to gain approval for the expansion. The Centers for Medicare and Medicaid Services (CMS) turned down Laguna Honda's request to reinstate the beds, citing federal regulations that require nursing facilities certified after 2016 to limit residents to two per room. Reinstating the 120 beds would have meant Laguna Honda would have three residents in some of its rooms. CMS can make an exception to this rule by granting nursing homes a waiver allowing them more than two residents per room if they can show it meets residents' needs and will not harm their health and safety. Laguna Honda sought such a waiver in April, and was notified by CMS on July 7 that it was denied. In a letter to Laguna Honda leaders, CMS cited concerns about privacy, infection control and resident safety. It also cited hundreds of allegations of non-compliance, including allegations of abuse, neglect and resident rights violations since the hospital was recertified in 2023. Laguna Honda leaders said this was a 'gross mischaracterization' and that only six of the 276 allegations of non-compliance resulted in a cited deficiency, and that for each deficiency, the hospital completed a plan of correction. Compared to other large nursing facilities in California, Laguna Honda ranks in the middle for reported incidents and below the median for deficiencies, they said. 'We are very disappointed,' said Roland Pickens, director of San Francisco Health Network, which is owned and operated by the San Francisco Department of Public Health and includes Laguna Honda. Since 2010, Laguna Honda had 769 beds and housed three residents in some rooms, known as triples, because federal regulations allow that for nursing homes certified before 2016. But in 2022, the hospital lost its Medicare certification after state inspectors identified moderate to very serious deficiencies at the facility, including many residents testing positive for narcotics. The inspection was launched in 2021 after two residents overdosed but survived. During the process of regaining Medicare certification — a two-year saga that threatened to shut down the facility altogether — Laguna Honda had to decommission the triple rooms, reducing its skilled nursing beds from 769 to 649. It regained Medicare certification in 2024, which means it must comply with the regulation that limits residents to two per room for facilities certified after 2016. Laguna Honda then sought the waiver to add back the 120 beds, citing the critical need for skilled nursing care in San Francisco. The facility currently has about 550 residents. Laguna Honda leaders said they strongly disagree with CMS's decision but will not appeal or seek litigation challenging it. 'Pursuing legal action would be costly, time consuming and unlikely to yield a timely or favorable result — especially given CMS's broad discretion and the current political climate,' the public health department said. 'In the face of ongoing federal and state threats to Medicaid funding, local health departments like SFDPH must focus on protecting the broader system of care.'
Forbes
a day ago
- Business
- Forbes
ACA Premiums Are Set To Spike For Some In 2026—How To Lock In Savings Now
Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations. Millions of Americans could lose a tax credit that saves them thousands of dollars on ACA Marketplace health insurance by the end of the year. The tax credit, initially expanded under the American Rescue Plan during the pandemic and later extended through 2025 by the Inflation Reduction Act, saw expanded eligibility beyond the income cap of 400% of the federal poverty level starting in 2021. These subsidies capped out-of-pocket premiums to no more than 8.5% of income for those who qualified. Unless Congress acts, the expanded eligibility will expire at the end of the year, creating what experts are calling a 'subsidy cliff' for enrollees with incomes above the 400% income threshold. The 2024 Open Enrollment report from the Centers for Medicare and Medicaid Services found enrollees at 400% of the federal poverty level saved an annual average of $4,248 on their health premiums. Losing eligibility for this tax credit could leave many Americans facing unaffordable health insurance costs. The Centers for Medicare and Medicaid Services reports the subsidy expansion of the tax credit led to increased enrollment in the ACA Marketplace, particularly in low-income communities and states that hadn't previously embraced the program. According to Kaiser Family Foundation, since 2020, enrollment in the ACA Marketplace has more than doubled, with 88% of the total growth—11.4 million out of 12.9 million new enrollees—in enrollment came from states won by Trump in 2024. States like Texas, Mississippi, West Virginia and Georgia saw their enrollment numbers more than triple. A household of two earning up to $84,600 (400% of the poverty level) currently qualifies for the tax credit. But if their income increases in 2026, they'll lose their eligibility that saves them $500 on monthly health insurance premiums—or $6,000 annually. 'It's one of the more lucrative credits that are out there for individual taxpayers,' says Tommy Lucas, a certified financial planner at Moisand Fitzgerald Tamayo. Talks to extend the enhanced tax credit have stalled in Congress, with House Republicans 'balking' at the thought, according to a Politico report . That means households already teetering past 400% of the federal poverty line—or those that know they'll exceed it next year—need to start making a financial plan now to stay within the income threshold limits. The battle, financial experts say, begins at the tax office. A few potential tax planning steps to take include: Tax loss harvesting : This investment method means investors sell investments that have lost value to help cancel out the taxes on their gains. Look at your portfolio to identify investments that are down and see if selling them could lower your tax bill. This investment method means investors sell investments that have lost value to help cancel out the taxes on their gains. Look at your portfolio to identify investments that are down and see if selling them could lower your tax bill. Leverage health savings accounts : You can claim tax deductions through contributions made to a health-savings account (HSA). With the new tax law that passed under the One Big Beautiful Bill Act, all Bronze and catastrophic plans under the ACA are considered HSA-eligible, starting in 2026. 'For single-filers, you can contribute $4,300, for families, the maximum is $8,550. There's a $1,000 catch-up contribution for those 55 and older, so you can effectively reduce and back away from the cliff by that amount,' says Lucas. You can claim tax deductions through contributions made to a health-savings account (HSA). With the new tax law that passed under the One Big Beautiful Bill Act, all Bronze and catastrophic plans under the ACA are considered HSA-eligible, starting in 2026. 'For single-filers, you can contribute $4,300, for families, the maximum is $8,550. There's a $1,000 catch-up contribution for those 55 and older, so you can effectively reduce and back away from the cliff by that amount,' says Lucas. Max out retirement contributions in tax-deductible accounts: One of the most effective ways to lower your taxable income is to contribute to a 401(k) or IRA, which offer upfront tax breaks. In 2025, individuals can contribute up to $23,500 to a 401(k) (plus an extra $7,500 if you're 50 or older), and up to $7,000 to a traditional IRA ($8,000 with the catch-up). 'This deferral of earnings will lower your taxable income exposure,' said Bill Shafransky, a senior wealth advisor at Moneco Advisors and a member of the Financial Planning Association. Lucas recommended turning to tax experts and services that can help enrollees navigate the 'complicated' process to keep their income within means. While individuals can and should file using free or low-cost tax software , a little expertise could go a long way. 'This is going to potentially be thousands of dollars in cost, so always talk to a professional who knows the ins and outs of this,' says Lucas. 'Open enrollment is coming up pretty soon in November, so start planning now.'
The Hill
2 days ago
- Health
- The Hill
Memo pushes back on bill's impact to rural hospitals
A new memo shared first with The Hill argues the law 'contains unprecedented levels of federal assistance to rural and other vulnerable hospitals' through its five-year, $50 billion Rural Health Transformation Program. The administration notes that Medicaid has historically invested very little in rural hospitals. According to figures from the Centers for Medicare and Medicaid Services (CMS), Medicaid spent just $19 billion on rural hospitals in 2024. The rural health fund will provide an additional $10 billion each year from 2026 through 2030. But it ends after 2030, with no phaseout period. The memo argues the fund is a 'flexible' source of investment because it's not tied directly to reimbursement for services. Indeed, as experts have noted, the fund will not make direct payments to rural hospitals. Instead, the money will go to states, which will need to first file detailed 'rural health transformation plans' and get approval from CMS Administrator Mehmet Oz. The law gives Oz broad discretion on what he can approve, and there is no specific requirement for states to direct funds to rural hospitals or CMS to approve only funding for rural districts. States also need to make funding decisions quickly, as the federal government can claw back unobligated money before the program ends. The new law cuts about $1 trillion from Medicaid, primarily through stringent work requirements as well as reductions to how states can fund their Medicaid programs through provider taxes and state-directed payments. Rural hospitals rely heavily on Medicaid funding because many of the patients they care for are low income. But the administration noted that rural hospitals only account for 7 percent of overall Medicaid spending. According to a KFF analysis, federal Medicaid spending in rural areas is estimated to decline by $155 billion over a decade because of the law.
Newsweek
2 days ago
- Health
- Newsweek
VA To Examine Health Payments To Veterans
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. The Department of Veterans Affairs (VA) has announced a new partnership with the Centers for Medicare and Medicaid Services (CMS) aimed at eliminating duplicate health care billing. The VA said on Tuesday that the agencies had identified $106 million spent on duplicate billings over the past six years for veterans enrolled in both VA health care and Medicare. It added that it will start to send bills to overpaid providers to recover the money from this month. Newsweek contacted VA and CMS for comment via email outside of regular working hours. Stock image. The VA has announced a new partnership with the Centers for Medicare and Medicaid Services aimed at eliminating duplicate health care billing for veterans. Stock image. The VA has announced a new partnership with the Centers for Medicare and Medicaid Services aimed at eliminating duplicate health care billing for veterans. dangutsu/Getty Images Why It Matters Federal officials said the recovery effort will both recoup taxpayer funds and help redirect resources towards veterans and Medicare benefits. Officials also said that the partnership will reduce waste and redundant paperwork. What To Know Approximately 5.9 million veterans are enrolled in both VA health care and Medicare, both of which pay for a variety of medical care from third-party providers. Until now, there was no centralized system in place to prevent double billing, which enabled overpayments to go unnoticed. The agencies have now established a data-matching agreement to spot when medical providers submit claims for payment to both VA and Medicare, aiming to prevent future overlapping claims. In addition to payment reforms, the VA announced on Tuesday that it had awarded more than $2 million in new grants to seven educational and research organizations as part of the Veterans Legacy Program. These grants aim to memorialize veterans through documentaries, digital storytelling, and educational projects that focus on veterans' contributions. What People Are Saying VA Secretary Doug Collins said in a statement: "We are proud to implement this commonsense reform, which should have been instituted years ago but is only happening now under the leadership of President Trump. The money we save as a result of this effort will be much better spent helping VA and Medicare beneficiaries get the benefits they've earned." CMS Administrator Dr. Mehmet Oz said: "For too long, government programs have operated in silos, enabling improper payments to slip through the cracks at the expense of taxpayers. Under President Trump's leadership, CMS is proud to partner with the VA to root out duplicate billing, recover taxpayer funds, and reduce redundant paperwork and waste so American Veterans and seniors receive the care they deserve." What Happens Next The VA and CMS plan to recover improper payments from providers has already begun.
Boston Globe
4 days ago
- Health
- Boston Globe
An attack on the medical establishment buried in an 1,800-page regulation
Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians. But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up 'We're modernizing Medicare by correcting outdated assumptions in how physician services are valued,' said Chris Klomp, a deputy administrator of the Centers for Medicare and Medicaid Services, in an email. Advertisement Robert F. Kennedy Jr., the secretary of health and human services, has emphasized that medicine should focus more on primary care and prevention, and less on the treatment of advanced diseases. He has also crusaded against 'corporate medicine,' and has specifically criticized the American Medical Association. Stat News reported in November that Kennedy was considering policies to disempower the AMA committee. Advertisement Dr. Bobby Mukkamala, the AMA's president, was highly critical of the proposed change. 'The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and health care professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process,' he said in a statement. The current AMA committee, known as the RUC, uses data gathered in surveys of doctors to set formulas for every kind of medical care. The committee suggests payment rates to Medicare's regulators, who almost always adopt them. The system is effectively zero-sum — any increases for one kind of doctor represents decreases for others. While private insurers are free to develop their own formulas for paying doctors, they tend to follow Medicare's lead, making the committee very influential on what kinds of medical care get the largest (and smallest) financial rewards. The estimates are often outdated. Existing payments are reviewed on average only once every 17 years. A Washington Post investigation in 2013 reported on numerous gastroenterologists who had billed Medicare for more than 24 hours' worth of colonoscopies a day. The reason wasn't fraud. Medicare was still paying the doctors as if each test took 75 minutes to complete, when most doctors were able to complete one in 30 minutes. (The colonoscopy payment has since been adjusted.) Under the new proposal, Medicare would pay 2.5 percent less for every procedure, operation and medical test in 2026, based on data suggesting there have been improvements in 'efficiency' over the years. Payments for treatments based only on time, like a consultation with a family physician or neurologist, would not be cut. Such adjustments would be repeated every three years. Advertisement The proposal also looks to change the kind of data Medicare should consider instead of the relatively small surveys, noting that new sources of health data from hospitals and electronic billing systems could offer more accurate information. The effort to adjust what doctors are paid for their work is just one part of the large rule, which also contains provisions to broaden coverage for telemedicine, pay for more mental health care, and reduce overpayments for a new and expensive type of skin bandage. One other provision, meant to better account for the costs of running a medical practice, also affects the relative pay of different medical specialists. In some cases, those changes would reduce payments to the types of medical specialists whom the efficiency adjustments are meant to benefit. That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere. Taken together, the overall proposal would do more than just increase the salaries of primary care doctors. It would also increase the average pay of an allergist next year by 7 percent, and decrease pay for a neurosurgeon by 5 percent, according to estimates published by Medicare. It would lower pay by 6 percent for infectious disease specialists, who tend to earn low salaries and perform few procedures -- and increase average pay for vascular surgeons by 5 percent. Dr. Adam Bruggeman, a spine surgeon in San Antonio who leads the council on advocacy for the American Academy of Orthopaedic Surgeons, said he was sympathetic to arguments that the current system may be paying for some medical procedures inaccurately. But he said the proposal — which would cut payments for all procedures next year — was too crude a solution to that problem. He described the 'efficiency' changes as 'taking an ax to the whole thing.' Advertisement 'We're just fighting an arbitrary number with another arbitrary number, and that doesn't help,' he said. This article originally appeared in
