In the latest episode of Another Word for Living, host Susan Wallace welcomes Kelly Ebbing, RN, with Hospice of Cincinnati and HOC Navigators—and a featured speaker at the upcoming Palliative Care Summit—for a timely and insightful conversation on advance care planning and palliative care.
Together, they explore how palliative care supports patients and families through meaningful discussions and practical tools. From crafting effective advance directives to earning that elusive “gold star” from your doctor, the episode offers guidance and resources that can be shared with both aging services professionals and the community.
The conversation is especially relevant as we recognized Healthcare Decisions Day on April 16, a reminder of the importance of making your wishes known before a medical crisis occurs.
Catch the episode here or on any major podcast platform. Top You Asked:
I read that the nursing home staffing rule has been overturned. What does this mean for the appeal of the lawsuit pending in the Iowa circuit court? Can we expect that suit to be cancelled?
We Answered:
The decision issued by Judge Matthew J. Kacsmaryk ruled that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority and violated the language of the Nursing Home Reform Law when it issued a final nurse staffing rule that required registered nurses around the clock and at least 3.48 hours per resident day (HPRD) of nurse staffing time. It is important for providers to know that the suit was built on specific portions of the rule: the HPRD requirements for RN, aide and all-nursing, as well as the 24/7 RN requirement. The suit was silent on other portions of the rule, including the requirement that nursing homes incorporate revised staffing concerns into their facility assessment. At this time, these portions of the rule remain in effect.
The Iowa case, led by 19 attorneys general and LeadingAge state chapters of 20 different states, includes arguments that the facility assessment has placed burden on providers now. It remains active.
You Asked:
In the revised CMS QSO memo taking effect April 28, has CMS provided any exceptions for hospices related to medications, including pain and psychotropic medications?
We Answered:
No, in the revised QSO-25-14- NH memo, effective April 28, 2025, CMS still notes that as described in §483.70(n)(2)(i), the nursing home must ensure that services provided by the hospice (including the individuals providing the services) meet professional standards and principles, that the services and care meet the assessed needs of each resident, and that the hospice is certified for participation in the Medicare program. (Refer to F675 and F658.) The nursing home and hospice must assure that all physician/practitioners meet State licensure requirements and are working within their scope of practice and professional State licensure requirements.
CMS does not exempt hospice providers from compliance with the Requirements of Participation related to unnecessary medications, psychotropic drug use, or pain management. Instead, CMS emphasizes that it is important for pain management approaches to follow pertinent professional standards of practice and to identify who is to be involved in managing the pain and implementing the care or supplying the services such as hospice agencies. Medication regimens for residents receiving end of life, palliative, or hospice care may include opioids alone or combining opioids and benzodiazepines; their use must be consistent with accepted standards of practice for this specialty of care.
Collaboration between the facility and hospice is essential, but the facility remains accountable for ensuring the resident’s medication regimen aligns with regulatory expectations. Top With the legalization of marijuana for both medical and recreational use in Ohio, post-acute care employers are navigating uncharted territory. What are your rights? What are your responsibilities? And how do you protect your workplace?
Join attorney Sam Lillard for an eye-opening session that breaks down Ohio’s evolving marijuana laws and what they mean for your organization. This must-attend presentation will cover:
- Ohio vs. federal marijuana laws
- Workers’ compensation implications
- Key legal frameworks you need to know
- Real-world case scenarios with actionable takeaways
Get clear answers to the questions you're already asking—and the ones you haven’t thought of yet. Don’t miss your chance to stay ahead of the curve and keep your workplace informed, compliant, and prepared.
Register here. Artificial intelligence is quickly becoming a creative partner in marketing and communications, but its effectiveness depends on the quality of its training—and the clarity of our prompts. At the next Marketing, Communications & Outreach (MCO) Network meeting on Thursday, April 24 at 11:30AM, we’ll examine how to guide AI tools like ChatGPT to support content development that reflects the person-centered values of professionals in aging services.
This session will focus on how communicators can train AI to reflect age-friendly language, avoid ageist tropes, and speak with the dignity and nuance our work requires. It all begins with the prompt. What you ask—and how you ask it—directly influences the response you receive.
We’ll also discuss how to balance automation with intention, including ethical considerations, accuracy checks, and the importance of maintaining a human voice in every message.
If you’ve ever asked, Can ChatGPT do that?—this session will help you ask a better question and receive a better response.
Networks are free for members, but registration is required. Top Following the April 7 Centers for Medicare and Medicaid Services’ 5.06% payment rate hike for calendar year 2026—more than $25 billion—for Medicare Advantage (MA) plans, providers will want to learn the ins and outs of establishing beneficial MA contract terms to maximize payments. Join LeadingAge Wednesday, April 23 as Grant Swemba, vice president, managed care for Strategic Health Care, walks through the full MA contract lifecycle and shares best practices to ensure providers get the most from MA plans. Register here. The revisions to Appendix PP Guidance to Surveyors for Long-Term Care Facilities will be implemented on April 28, 2025. LeadingAge has created quick reference guides for an overview of changes in four key areas: Admissions Policy, Assessment and Diagnosis, Transfer and Discharge, and Unnecessary Medications. These guides highlight the main takeaways for each topic, impacted F-tags and relevant Critical Element Pathways, tips for what you can do to work toward compliance, and provide answers to the most frequently asked questions from members. The resources are available on the RoPs Tools and Resources page on the LeadingAge website and require a LeadingAge login to access. The challenges of safety for skilled nursing and memory care residents are being met by increasingly sophisticated technologies, as demonstrated by the newly updated LeadingAge CAST Safety Technology Selection Tool, which includes fresh details on 50 products as well as information on seven new ones. Also included (along with a white paper, online matrices, and an online selection tool) are three new case studies on providers’ experience with safety technologies—including an emergency communication and response system and two new artificial intelligence-powered fall detection and prevention technologies. Read more about the possibilities. LeadingAge experts develop essential advocacy, guidance, and tools—the most relevant resources for members. Here’s what’s new:
Top This week, the Department of Aging requested LeadingAge Ohio remind its members that VOVID-19 rapid antigen tests are available for facilities to order, free of charge, through the ODA Care Center Portal until April 30 for those opted into the state-supported testing program with an active CLIA Certificate of Waiver on file.
After April 30, facilities are encouraged to work directly with their facility’s pharmacy provider or community pharmacies to secure these tests. This announcement comes as the last of COVID-era programs are being wound down. The HHS Office of Inspector General (OIG) issued a report on April 10, that found Ohio in non-compliance with federal waiver and state requirements at 18 of 19 adult day sites that were selected for review. According to the report, the reviews identified over 100 health and safety issues, many pertaining to buildings and facilities, in all but one adult day programs surveyed. The surveyed programs included those involved in waivers administered by the Departments of Aging, Medicaid and Developmental Disabilities.
The OIG found that the Ohio Department of Medicaid (ODM) did not fully comply with federal waiver and state requirements in overseeing providers that serve adults receiving ADS through the program because its inspections of facilities were insufficient to ensure a continuously safe and nonhazardous environment.
- Of the 19 providers that OIG reviewed, 18 did not comply with 1 or more health and safety requirements, and 9 did not comply with 1 or more administrative requirements.
- The OIG found 117 instances of provider noncompliance with health, safety, and administrative requirements.
- Providers of ADS did not always meet the needs of program participants or maintain compliance with State requirements.
As a result, the OIG has issued recommendations to ODM to ensure provider compliance in these areas. The full report, including ODM’s response, and the HHS OIG recommendations can be found here.
Similar reports demonstrate that these problems are not limited to Ohio; the report indicates that 16 other states were found to be in noncompliance. The best-performing state among those surveyed was Kentucky, which still found 14 of 20 adult day facilities reviewed in noncompliance.
In a response included in the report, ODM promises to ensure providers correct instances of noncompliance, improve oversight and monitoring of providers through a statewide quality improvement plan, and work with providers to improve their facilities, staffing and training.
The report comes at the tail end of a year-long project to expand adult day services in Ohio, whereby LeadingAge Ohio provided technical assistance to entities receiving grant assistance through the Adult Day Revitalization Program funded by remaining ARPA dollars. The results of the report underscore one of the key recommendations emerging from the report: that Ohio adult day operators need more hands-on assistance navigating regulatory requirements, especially during the startup phase.
Notably, many of the areas of noncompliance relate to life safety code issues and the environment of care, which is likely to be one area of focus for remediation efforts.
LeadingAge Ohio remains steadfast in its commitment to supporting adult day services across the state. Adult day services are a critical and underutilized component of the care continuum, providing socialization and respite to family caregivers enabling them to work, rest and attend to needs like errands, medical appointments and the like. Adult day services reduce caregiver burden and support their wellbeing, and Ohio still has a long way to go in terms of rebuilding this important service.
Questions may be directed to Randi Hamill at rhamill@leadingageohio.org or Eli Faes at efaes@leadingageohio.org. Top The Centers for Medicare & Medicaid Services on April 11 released two proposed rules, one for hospice and one for skilled nursing facilities. The former includes a proposed payment update of 2.4% and a number of requests for information, as this LeadingAge summary explains. For skilled nursing facilities, the agency proposes a rate increase of 2.8%, as well as updates to the requirements for the SNF Quality Reporting Program and to the SNF Value-Based Purchasing Program. Find details here. Project PAUSE (Psychoactive Appropriate Use for Safety and Effectiveness), a coalition of national stakeholders of which LeadingAge is a part, is urging the U.S. Health and Human Services (HHS) to remove the problematic Long-Stay Antipsychotic Medication measure from the Five Star Quality Rating System on Care Compare. The April 9 letter to HHS Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz advocating for the measure’s removal explains the measures shortcomings, including not distinguishing between appropriate use of antipsychotic medications and unnecessary use of antipsychotic medications. Learn more here. Top The Centers for Medicare & Medicaid Services (CMS) announced in an April 17 newsletter that it has extended the deadline for off-cycle revalidation for all Medicare-certified nursing homes to be completed from May 1 to August 1. The extension is great news for providers working to comply with the deadline, but were challenged with a complicated array of submission requirements. Previously, LeadingAge worked to successfully secure a submission extension from October 1, 2024, to May 1, 2025. The new deadline gives providers additional time to collect data on ownership, managerial, and related party information and submit their revalidation.
LeadingAge recently provided additional resources to help providers comply with the revalidation requirements. We have compiled a quick reference guide here to the available resources from CMS. We also encourage members to check out the recording of the February 11 webinar Understanding the New Off-Cycle Nursing Facility Revalidations. The Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on the compare tool on Medicare.gov and Provider Data Catalog (PDC) during the July 2025 refresh.
Data contained within the Provider Preview Reports are based on quality assessment data submitted by SNFs from Quarter 4, 2023 through Quarter 3, 2024. The Centers for Disease Control and Prevention (CDC) measures reflect Influenza Vaccination Coverage Among Healthcare Personnel measure data from Quarter 4, 2023 through Quarter 1, 2024, and COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure data from Quarter 3, 2024. The claims-based measures reflect data from Quarter 4, 2021 through Quarter 3, 2023 and the SNF Healthcare-Associated Infections (HAI) measure data from Quarter 4, 2022 through Quarter 3, 2023.
Providers have until May 15, 2025, to review their performance data. Only updates/corrections to the underlying assessment data before the final data submission deadline will be reflected in the publicly reported data on Medicare.gov. If a provider updates assessment data after the final data submission deadline, the updated data will only be reflected in the Facility-Level Quality Measure (QM) report and Patient-Level QM report. Updates submitted after the final data submission deadline will not be reflected in the Provider Preview Reports or on Medicare.gov. However, providers can request a CMS review of their data during the preview period if they believe the displayed quality measure scores within their Provider Preview Reports are inaccurate.
For those users experiencing issues locating their agency’s SNF Provider Preview Report, follow the steps outlined below:
- Log into iQIES using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password. (If you do not have a HARP account, you may register for a HARP ID.)
- From the Reports menu, select My Reports.
- From the My Reports page, locate the SNF Provider Preview Reports folder. Select the SNF Provider Preview Reports link to open the folder.
- Displayed for you is a list of reports available for download. The reports or files are listed in descending order and the newest files are displayed at the top of the list.
- Select the desired SNF Provider Preview Report name link and the report will display.
New Users
New users will automatically receive the latest Provider Preview Report in their SNF Provider Preview Report folder once their new iQIES user role is approved. Follow the steps above to locate your agency’s report in the SNF Provider Preview Report folder.
For questions related to accessing your facility’s Provider Preview Report, please contact the iQIES Service Center by email at iqies@cms.hhs.gov or call 1-800-339-9313. For questions about SNF Quality Reporting Program (QRP) Public Reporting, please email SNFQRPPRQuestions@cms.hhs.gov. In the revised QSO-25-14- NH memo, effective April 28, CMS defines subacute pain and expands guidance on pain management in nursing homes. CMS emphasizes that nursing home residents are at high risk for having pain that may affect function, impair mobility, impair mood, or disturb sleep, and diminish quality of life. Subacute pain, as defined by the CDC, is pain that has been present for 1–3 months. The CDC also notes that continuing opioid therapy during the subacute time frame might represent the start of long-term opioid therapy. Residents should be encouraged to talk to their doctor and the interdisciplinary team about your treatment goals and the benefits and risks of different types of treatment for subacute pain.
CMS notes that prescribing practitioners may find that opioid medications are the most appropriate treatment for acute pain, subacute pain, and chronic pain in some residents. Opioid treatment for pain needs to be appropriately assessed and individualized for each resident. However, because of increasing opioid addiction, abuse, and overdoses, prescribers should use caution when prescribing opioids, and consider using alternative pain management approaches, when appropriate. When opioids are used, the lowest possible effective dosage should be prescribed for the shortest amount of time possible after considering all medical needs and the resident should be monitored for effectiveness and any adverse effects. When starting opioid therapy for acute, subacute, or chronic pain, clinicians may consider prescribing immediate-release opioids instead of extended-release and long-acting.
To read the complete Survey Tip of the Week, please click here. Top Plante Moran Living Forward (PMLF), a trusted development advisory firm in the senior living sector, has welcomed three new leaders to its team: Matt Pyles, Jennifer Vasil, and Tim Moran.
The firm continues to grow in response to increased demand for expertise in areas such as development strategy, operational sustainability, and capital planning. Each new team member brings extensive experience to help senior living organizations navigate today’s evolving landscape.
Matt Pyles joins as principal and will lead PMLF’s senior living development advisory service line. With more than 20 years of experience in strategic finance, investments, and planning, Pyles will support clients in executing vision-aligned, long-term development goals.
Jennifer Vasil, BSN, RN, LNHA, joins as senior vice president, offering operational, reimbursement, and clinical consulting expertise. Her background in skilled nursing leadership equips her to support providers in improving performance while preparing for repositioning or expansion.
Tim Moran joins as vice president on the project management team, bringing over two decades of experience in design, construction, and capital project oversight. His work will support clients planning large-scale renovation and expansion initiatives.
Read the full announcement via Skilled Nursing News:
Plante Moran Living Forward Welcomes Three New Executives Top In a recent on-demand session, LeadingAge Ohio’s Stephanie DeWees presented a comprehensive overview of how nursing homes are being cited during their annual surveys. The presentation focused on recent and significant updates to the Long-Term Care Survey Process, which aim to improve regulatory oversight—particularly in relation to staffing compliance across all service departments including nursing, activities, and dietary services.
Surveyors are now required to assess staffing sufficiency whenever concerns are identified that relate to the quality of care, quality of life, actual harm, or situations that may place residents in immediate jeopardy. These changes reflect a growing emphasis on resident-centered care and facility accountability.
One of the key updates includes the use of the Payroll-Based Journal (PBJ) Staffing Data Report as a central investigative tool. Surveyors are leveraging this data to detect potential noncompliance, providing a more data-driven foundation for identifying staffing issues and determining citations.
The session provided an in-depth review of the revised surveyor guidance, the investigative protocols they now follow, and the primary indicators that can trigger staffing-related citations. Participants gained valuable insights into how PBJ data is utilized during surveys and learned proactive strategies to identify and address staffing challenges before they escalate into regulatory deficiencies.
This session is available on-demand for those who want to better understand these regulatory changes and how to prepare their facilities for a successful survey outcome.
To view this On-Demand recording, please click here. LeadingAge Ohio Partner Value First has announced a new partnership with Omnicare, a market-leading pharmacy provider with over four decades of service excellence, backed by clinical expertise. Omnicare offers broad, customizable, and innovative solutions to help you grow. Omnicare takes pride in providing exceptional customer service and unmatched expertise at an exceptional value founded by a culture of empathy, integrity and service.
Read the complete release from Value First here. LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events. Top
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