LTC Clarified: Weekly News, Insights & Connections

A strong grievance program is more than a regulatory checkbox—it’s a direct reflection of how your facility listens, responds, and improves. Under F585 in the Centers for Medicare & Medicaid Services State Operations Manual (Appendix PP), facilities must maintain a grievance process that is accessible, responsive, and resident-centered. This guide brings together regulatory expectations, surveyor insights from CMS Form 20057, and actionable steps to keep your facility both compliant and compassionate.

Navigate the Quality Measures (QMs) that define SNF performance with practical strategies to improve outcomes, strengthen compliance, and protect reimbursement. Participants will develop a clear understanding of how key measures are defined, coded, and calculated—and how day-to-day clinical practice translates into overall facility performance. Learn more and register here.

Q: We are in the process of reviewing the Restorative Nursing Ambulation program. Some residents are only able to walk very short distances. Would these patients be appropriate for the program?



This full-day training will focus on restorative nursing programs (RNP) including program fundamentals and regulatory requirements. Attendees will gain insight into evaluating RNP candidates, the connection between restorative programming and Medicaid and Medicare reimbursement, care planning and documentation techniques, and staff training requirements. Take advantage of this opportunity to advance your Restorative Nursing Program success! Learn more & register here.

MARCH: Check out these upcoming March webinars!

APRIL: Check out these upcoming April webinars!

CMS Rule Phases Out Fax Machines, Snail Mail

CMS has finalized the Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule (CMS-0053-F) which replaces faxing and mailing for more streamlined electronic transactions when submitting additional claims-related documentation requested by health plans, including medical records, X-rays, clinical notes, telemedicine visit documentation, and laboratory results. New standards establish a consistent, secure electronic framework for transmitting this documentation, improving efficiency across the entire healthcare system. The rule also establishes requirements for electronic signatures. The standards adopted in this rule apply to Health Insurance Portability and Accountability Act (HIPAA)-covered entities, including health plans, healthcare clearinghouses, and healthcare providers that conduct electronic transactions. The rule is effective on May 19, 2026 [60 days after publication in the Federal Register]. Covered entities must comply by May 19, 2028 [24 months of the effective date]. View the final rule fact sheet.

New FFS Advance Beneficiary Notice of Noncoverage (ABN) Available

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service - FFS) beneficiaries in situations where Medicare payment is expected to be denied. Note: Skilled nursing facilities (SNFs) issue the ABN to transfer potential financial liability for items/services expected to be denied under Medicare Part B only.. Guidelines for issuing the ABN can be found beginning in Section 50 in the Medicare Claims Processing Manual, 100-4, Chapter 30 (PDF).   The Office of Management and Budget (OMB) has approved the control number for the Advance Beneficiary Notice of Non-coverage (ABN) (CMS-R-131). The updated ABN is effective now and expires March 31, 2029.  Providers may continue to use the expired version of the ABN until May 12, 2026, but must transition to the approved form no later than that date.

Medicaid Fraud Control Unit Annual Report FY2025

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG released a new report analyzing case outcomes submitted by 53 MFCUs for Fiscal Year (FY) 2025. In FY 2025, MFCUs operating across all 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands reported 1,185 convictions, 900 exclusions from federally funded health care programs, and 674 civil settlements and judgments — totaling $2 billion in recoveries. Overall, MFCUs recovered $4.64 for every $1 spent in FY 2025.  

iQIES Reports User Manual v. 2.11

The iQIES Reports User Manual version 2.11 updated March 19, 2026 is available.

Make progress with 2026 goals and wish-list projects on a Proactive Annual Partner Plan which provides an allotment of consulting support hours delivered by seasoned LTC experts at a fraction of the cost of hiring new staff. Support is lead by a designated consultant, and can be provided as a combination of onsite and remote assistance with services billed in 12 flat monthly installments. Plans start as low as 8 hours per month with facility customized work plans that provide just-right support for survey-readiness, QM improvement, key clinical programs, reimbursement accuracy and crisis management. Add the Proactive team to your roster and achieve the outcomes you’ve been working toward! Contact us to learn more.