From McKnight’s Long-Term Care News — By James M. Berklan —
While a preponderance of long-term care stakeholders are still reeling days after President Trump signed a major budget law, a minority of providers point to it with optimism. They say more than a half-dozen aspects of it should give providers reasons for cheer.
“Passage of the reconciliation — colloquially dubbed the ‘Big Beautiful Bill’ — marks a significant win for long-term care providers, especially in its provisions addressing Medicaid provider taxes and continuity of care for vulnerable populations,” said Joe Steier, CEO of Signature HealthCARE, which has 72 senior care facilities in 10 states.
Nursing home provider taxes are “imperative to help cover the share of Medicaid costs we incur,” he added. “For years, our sector has been left out of broader health reform conversations and this validates our role in the healthcare continuum.”
Skilled nursing operators will not see cutbacks in current provider taxes, which had been on the table originally and will take place for hospitals and other providers.
“We are also encouraged by some of the streamlining of operational obstacles such as the bill’s enhancement of transparency and fairness in CMS’s Value-Based Purchasing Program by adjusting performance metrics to account for sociodemographic factors allowing providers to focus more on patient care,” Steier said.
Tempered enthusiasm
Long-term care providers and many other stakeholders have broadly criticized the budget bill, which will cut a projected $1 trillion in Medicaid support over the next decade. Rural and smaller operators figure to suffer the most.
But Steier chooses to look for positives, despite some admittedly sizable negatives. He said he is most concerned about the budget’s effects on the company’s rural locations and noted that internal assessments are ongoing.
“We can only hope that policymakers will continue to engage in critical conversations for a more sustainable, equitable patient-centered future,” he told McKnight’s Long-Term Care News.
Another positive touch that he and others point to is the preservation of the Medicaid retroactive eligibility window at 60 days. Lawmakers in the House had proposed cutting it from the current 90 days to 30.
Steve LaForte, chief financial officer and principal of Cascadia Healthcare, joined Steier along with many others in hailing the 10-year moratorium of the nursing home staffing mandate. The “story of the year” since being introduced, the mandate’s demands would have crushed many providers, advocates have emphasized.
“Any bill of the magnitude of effect like the Big Beautiful one will have pros and cons in it,” LaForte observed.
Medicare safe?
While some observers happily pointed out that OBBBA didn’t directly attack Medicare funding, others pointed out that Medicaid and Medicaid are inextricably linked. When one is punished, the other is pressured. Also, sequestration payment cuts loom as a distinct possibility in a future SNF PPS Final Medicare Payment Rule.
On another front viewed as a positive, physician advocates praised the new budget for including a 2.5% increase to the Medicare Physician Fee Schedule’s (MPFS) Conversion Factor for 2026. But like most “wins” in the package, it is neither a complete nor permanent victory.
“The one-time assistance for 2026 is positive and a win and will help with an anticipated cut to the CF that CMS may release in the CY2026 MPFS any day now,” ADVION members were told in a briefing on the budget.
ADVION had advocated for tying the MPFS to an inflationary measure, and the House included a complex formula along those lines, but the Senate turned instead to the 2.5% adjustment, which is for 2026 only.
“We will need to come back next year and renew our call for permanent mitigation of PFS reductions for 2027 and beyond. Unfortunately, there is no relief for 2025 included and we do not anticipate Congress providing an additional update this year for 2025,” ADVION report authors noted.
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PHOTO (ABOVE): JoeSteier.com photo
Joe Steier, CEO of Signature HealthCARE, with long-term care facility residents.