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The impact of New York’s profit caps on nursing home development | Reuters

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The impact of New York’s profit caps on nursing home development | Reuters

December 28, 2021 - As we get ready to turn the page to 2022, one hesitates to continue to discuss the COVID-19 pandemic. However, the fallout continues, with fresh ramifications for the long-term care industry. The industry continues to receive heightened scrutiny following the pandemic, and New York's legislative answer to the concerns are set to hit nursing home businesses in New York as of Jan. 1, 2022, with a cap on allowable profits. The impact on capital outlays and acquisitions remains to be seen.

Both legislatively and through executive action, the State of New York began introducing fresh proposals impacting nursing homes in March 2021. The goal of the legislation was to ensure nursing homes, which receive government funding, spend at least 70% of their revenues on direct resident (patient) care, 40% being utilized directly to pay staffing costs for resident-facing staffing such as registered nurses, licensed practical nurses and nursing aides, with requirements on the minimum number of hours such staff need to spend with a patient per day.

Additionally, which is the larger concern of the two items, New York decided that nursing home businesses should not be operated for profit and, effective Jan. 1, 2022, it has capped allowable profits for nursing home businesses at no more than 5%, as determined by revenue and expenses reported on Medicaid cost reports.
Map: Degrasse State Forest

Shots – Health News : NPR

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Surprise medical bills are the target of a new law. Here’s how it works : Shots – Health News : NPR

Patients are months away from not having to worry about most surprise medical bills — those extra costs that can amount to hundreds or thousands of dollars when people are unknowingly treated by an out-of-network doctor or hospital.

The No Surprises Act — which takes effect Jan. 1 — generally forbids insurers from dropping such bills on patients and, instead, requires health care providers and insurers to work out a deal between themselves.

Some observers have speculated that the law will have the unintended consequence of shifting costs and leading to higher insurance premiums.

Many policy experts told KHN that, in fact, the opposite may happen: It may slightly slow premium growth.

The reason, said Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, is that a new rule released Sept. 30 by the Biden administration appears to "put a thumb on the scale" to discourage settlements at amounts higher than most insurers generally pay for in-network care.

Why Hospitals and Health Insurers Didn’t Want You to See Their Prices – The New York Times

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Why Hospitals and Health Insurers Didn’t Want You to See Their Prices – The New York Times

This year, the federal government ordered hospitals to begin publishing a prized secret: a complete list of the prices they negotiate with private insurers.

The insurers’ trade association had called the rule unconstitutional and said it would “undermine competitive negotiations.” Four hospital associations jointly sued the government to block it, and appealed when they lost.

They lost again, and seven months later, many hospitals are simply ignoring the requirement and posting nothing.

But data from the hospitals that have complied hints at why the powerful industries wanted this information to remain hidden.

It shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test.

And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.