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In this week’s episode of HealthCap Weekly Wrap, we explore the latest regulatory, clinical, and operational developments impacting senior care providers. Topics include Medicare Advantage prior authorization denials for skilled nursing facility admissions, new CMS survey oversight guidance, Medicaid work requirements, updated CDC infection prevention expectations, medication appropriateness recommendations for older adults, and insight into how surveyors are being trained to document deficiencies.

Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials — A new HHS OIG report found that 95% of appealed Medicare Advantage denials for skilled nursing facility admissions were overturned, raising concerns about the appropriateness of initial denial decisions.

Admin Info Memo 26-06-NH — CMS released fiscal year 2026 guidance for federal monitoring surveys, emphasizing survey consistency, documentation quality, and oversight of state survey agency performance.

Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule with Comment Period (CMS-2454-IFC) — CMS outlined implementation of new Medicaid community engagement requirements that will require certain beneficiaries to complete qualifying work, education, or service activities to maintain eligibility.

NHSN Long-Term Care Facility Component Manual — The CDC updated its NHSN guidance for long-term care providers, reinforcing expectations around infection surveillance, antibiotic stewardship, hand hygiene, and multidrug-resistant organism monitoring.

Screening for Potentially Inappropriate Prescribing in Primary Care — A new Canadian guideline encourages regular medication reviews for adults age 65 and older and supports structured deprescribing efforts to reduce medication-related harms.

Basic Writing Skills for Survey Staff (BWSSS) — This CMS training program highlights plain-language writing, documentation standards, and Form CMS-2567 best practices that help shape how survey findings are recorded and communicated.