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LTC Update | Oct 3, 2025

Date postedOctober 3, 2025

STATE

  •  The Senior Health Information and Insurance Education (SHIINE) can assist Medicare Beneficiaries by:
    • Understanding their Medicare options
    • Assisting with plan comparisons or enrollments
    • Assisting with Medicare appeals or billing issues
    • Educating about fraud prevention, assisting with detecting, and reporting fraud
    • Assisting with Assistance program applications

Our Senior Health Information and Insurance Education (SHIINE) Program has some exciting news! The SHIINE program has officially gone live with its statewide toll free number that is answered by a call center.  Any calls placed to the previous regional office numbers will be forwarded to this number as well unless the regional office’s direct lines are used. Now any South Dakotan Beneficiary/ family member/ caregiver can call the statewide number and the call center agent can answer simple questions, direct the caller to the nearest SHIINE team member, and/or schedule an appointment at the nearest available physical SHIINE location.

With Open Enrollment around the corner (October 15- Dec 7), SHIINE team members are ready to take appointments and assist beneficiaries with comparing plans!

 SHIINE Statewide Number:  888-854-5321

 The call center hours are Monday to Friday 8am to 8pm CT.

SNF

  • (NEW) CMS Revises CMP Reinvestment Program. The Centers for Medicare & Medicaid Services (CMS) released memo QSO-25-26-NH on September 29 outlining revisions to the Civil Money Penalty Reinvestment Program (CMPRP). The memo states that project funding caps will be increased from $5,000 to $6,000; certain technologies will be permitted as allowable expenses; and CMPRP funds will also be permitted for funding of projects related to behavioral health and workforce development.  Workforce development includes projects to improve the competency, education, and training of staff including nurse aides and registered nurses and is meant to complement activities initiated by CMS in the Nursing Home Staffing Campaign. CMS is also making further revisions to program processes to include a standardized application and updated project reporting parameters. CMS will now require demonstrated success in meeting project goals and objectives before allowing for approval of projects in other states. Program revisions go into effect on October 9 and CMPRP resources are expected to be updated by October 6.

HOME HEALTH

  • (NEW) HHVBP Preliminary CY2025 Annual Performance Reports (APRs) Posted. The Centers for Medicare and Medicaid Services (CMS) posted Preliminary CY 2025 Annual Performance Reports (CY 2025 APRs) for the expanded Home Health Value Based Purchasing (HHVBP) Model on iQIES. As a result of the recalculation request process which required agencies to submit requests by September 9, CMS adjusted the CY 2025 APR data used for home health agencies (HHAs) in the larger-volume cohort. This adjustment resulted in a slightly higher Adjusted Payment Percentage (APP) for some HHAs in the larger-volume cohort. If your HHA is in the larger-volume cohort, please compare your HHA’s APP in the Preview CY 2025 APR to the APP reported in the Preliminary CY 2025 APR to see if your HHA was impacted. If your HHA is in the smaller-volume cohort, no changes to your HHA’s APP were made. As a reminder, the CY 2025 APR is based on performance in CY 2024, the performance year. The APP will be applied to Medicare Fee-for-Service (FFS) claims with through dates in the payment year, CY 2026.

LeadingAge – Must be a member to access resources 

  • National Policy Pulse Call. LeadingAge’s members-only briefing and analysis call with our experts, “National Policy Pulse,” happens every Monday at 3:30 p.m. ET. Register for the calls (registration required even if you were registered for the previous 3:30 p.m. policy update calls) here. 

  • (DEADLINE APPROACHING) Register for Navigating the 2025 CMS Surveyor Guidance on the LeadingAge Learning Hub. Registration is now open for Navigating the 2025 CMS Surveyor Guidance. Join us on October 7 for this 90-minute webinar focusing on the April 2025 updates to the State Operations Manual, Appendix PP, Long-Term Care Surveyor Guidance. This session will explore early trends emerging nationwide, drawing from actual state survey outcomes and mock surveys performed by presenting partner Polaris Group Consulting Services. Check it out and register today on the LeadingAge Learning Hub.

OTHER

  • (NEW FOR SNF, HH, HOSPICE) More Shutdown Details for Nursing Homes, Hospice, Home Health. The Centers for Medicare & Medicaid Services (CMS) released memo QSO-26-01-ALL on October 1 providing additional detail on contingency plans for the federal government shutdown related to a lapse in appropriations for Fiscal Year 2026. As noted in the FY 2026 CMS Lapse Plan, survey and certification activities will be limited during the shutdown. Survey activities for nursing homes will be limited to investigations of complaints that are triaged at levels of immediate jeopardy or alleging actual harm. Revisits, either desk revisits or on-site revisits, will only be conducted in situations where a revisit is required to prevent termination of Medicare participation. Enforcement activities related to these surveys will continue. Informal Dispute Resolutions (IDRs/IIDRs) related to these surveys will also continue only in circumstances where an immediate adverse action will be taken during the period of shutdown. All other survey activities and IDRs will be suspended until further notice. For revisits that are necessary to end a per-day civil money penalty (CMP) or denial of payment, these revisits will not occur; however, CMS will provide instructions on how these situations will be handled subsequent to the government shutdown. It is also noted that while the Centers for Disease Control & Prevention (CDC) did not adopt COVID-19 vaccine recommendations prior to the government shutdown, nursing homes should continue efforts to comply with requirements for educating and offering COVID vaccines and for reporting COVID vaccination status of healthcare personnel through the National Healthcare Safety Network (NHSN). The definition of “up to date” has not been determined for Quarter 4 reporting, which began September 29, but providers should continue to report according to the Quarter 3 definition until further notice. The memo also contains details on hospice and home health surveys that we will provide more detail on tomorrow — notably, hospice surveys funded by the Consolidated Appropriations Act of 2021 (standard surveys every 3 years and SFP surveys which have not yet commenced) are considered mandatory and will continue during the shutdown. 

  • (NEW) MLN Notice On Telehealth Related to Shutdown Released. On October 1, CMS released an MLN article on telehealth policy changes triggered by the shutdown. The MLN notes that when certain legislative payment provisions (“extenders”) are scheduled to expire, CMS directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold. This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements. The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date and should have a minimal impact on providers due to the 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted. The MLN also discusses issuing Advanced Notices of Beneficiary Non Coverage. 

  • (NEW) LeadingAge Analysis of Second Bipartisan Bill Addressing MA Prompt Payment of Provider Claims Available.  LeadingAge has completed an analysis of S 2870/ HR 5454, a second bipartisan bill to address Medicare Advantage (MA) prompt payment of providers. This bill would standardize prompt pay timelines across all MA organizations and position the Secretary of Health and Human Services as the enforcer of those provisions through an HHS-MA plan contract and required plan reporting of data on payment practices. The bill would require MA plans to pay providers interest for every day a plan is late in paying the provider beyond the established payment deadlines and HHS would be required to assess civil monetary penalties for MA plan non-compliance. If passed, the legislation would both lend more predictability to provider payment and help to correct current barriers to prompt payment. LeadingAge looks forward to working with the group of bipartisan and bicameral sponsors of the legislation to see its passage and enhance some of its provisions. 

  • (NEW) What Does Shutdown Mean for Medicare and Medicare Advantage.   During a shutdown, Medicare payments continue to flow to providers and Medicare Advantage (MA) plans. MA Annual Open Enrollment will begin on October 15, as scheduled, and the Medicare plan finder at Medicare.gov has already been updated and is live with 2026 MA plan offerings, as of October 1. We also understand that beneficiaries will still be able to get their benefits questions answered at 1-800-Medicare but wait times may be longer. The Department of Health and Human Services (HHS) notes in their CMS lapse plan that certain outreach and education activities will cease or slow down though there are not a lot of specifics. “This could include local and national engagement activities, Medicare card and other mailings, and other beneficiary facing activities.” We expect that State Health Insurance Program offices that assist Medicare beneficiaries in evaluating their Medicare options will be unavailable during the shutdown. CMS will be operating at 50% staffing during this time.  

EDUCATION

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