Select each title below to read more:
IRS Releases Early Draft of 2026 W-2 Form
Effective from 2025 through 2028, individuals who receive qualified overtime compensation may deduct the pay that exceeds their regular rate of pay that is required by the Fair Labor Standards Act. We have been monitoring the IRS website for guidance relating to implementation of this provision, which was included in H.R. 1 the final 2025 budget reconciliation bill. This IRS webpage relating to the budget bill has for some time stated generally that employers required to file information returns furnish statements to employees showing the total amount of qualified overtime compensation paid during the year, and that it will “provide transition relief for tax year 2025 for taxpayers claiming the deduction and for employers and other payors subject to the new reporting requirements.”
While we have been expecting some guidance to issue relating to 2025 but not yet seen it, we noted that the IRS has issued a draft form W-2, box 12 of which includes a new code (“TT”) to capture the total amount of an individual’s qualified overtime compensation. This is an “early release draft” and is not yet final. We will continue to monitor for updated guidance.
LeadingAge Provides Input on OIG Study of MA Prior Authorization Practices for SNF Services
The Office of the Inspector General (OIG) has been examining how Medicare Advantage Organizations (MAOs) handle prior authorization requests in inpatient post-acute care (PAC) services for skilled nursing facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs) and Long Term Acute Care Hospitals (LTCHs). This study is a follow up to a 2022 OIG study on MA prior authorization denials, which OIG staff indicated showed “notable differences in denials” for these PAC services. LeadingAge advocated for OIG to pursue this deeper look at denials in PAC.
OIG is currently in the middle of their evaluation and have observed some trends on which they sought our perspective. One of these trends is that individuals who typically reside in a long-stay nursing home prior to a hospitalization appear to have much higher denial rates for SNF services than those who live in the broader community. OIG is also seeing patterns of dual eligibles being denied SNF services at higher rates than non-duals, which is particularly interesting since dual eligibles tend to have higher clinical complexity and needs and therefore, the opposite would be expected. We were also asked to share our perspective on some MAOs assertions about why these populations experience high rates of denials.
LeadingAge shared information solicited from our members through our Managed Care Solutions Network and individual outreach at an August 20 meeting. We explained that Part B therapy services are rarely, if ever, an equivalent level of service to receiving the more intense SNF-based therapy services because Part B services tend to be shorter in duration and less frequent. As a result, this type of service substitution approach can lead to a longer restoration time for the older adult to regain their full function.
We also noted that our members reported that some SNFs aren’t seeing LTC residents being denied SNF services but are noticing instead that lengths of stay for those individuals are for a shorter duration than those previously residing in the community. OIG said that length of stay is not being examined currently as part of this study but could be examined in a future study.
One study that they are particularly interested in pursuing is looking at cases where PAC providers don’t agree with an MAOs decision to end care and services. They asked again where we might suggest they look to see this disagreement documented or what might serve as a proxy (e.g. last day of coverage appealed). We explained many of our SNFs will assist with these last day of coverage appeals but also underscored that assisting with appeals just adds to the administrative burden providers already face by participating in MA plans. It was a positive meeting, and we were able to provide context and examples that counter some misimpression that some MAOs expressed. The final report from the OIG is expected in Spring 2026.
Summary of Proposed 2026 Physician Payment Rule: Reimbursement Increase, Telehealth Provisions, Medicare Policy Changes
LeadingAge is analyzing CMS’s annual proposal relating to Medicare payments under the Physician Fee Schedule and related Part B policy issues, and we are outlining issues to address in our comment letter. Among other issues, CMS is proposing telehealth flexibilities, as well as proposed changes to the Medicare Shared Savings Program. The proposed rule is open for public comment through September 12, and a Fact Sheet is available here. This LeadingAge article provides an overview of selected proposals that will be of interest to aging services providers.
HHS Seeks Nominations for Federal Healthcare Advisory Committee
The U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid (CMS) announced on August 21 that they are establishing a Healthcare Advisory Committee and seeking nominations of experts to be members of the committee. The committee will be charged with delivering strategic recommendations to the HHS Secretary and CMS Administrator on how to improve health care financing and delivery across Medicare, Medicaid and the Children’s Health Insurance Program, and the Health Insurance Marketplace to restore patient-centered care. Once the nomination request is published (expected August 22, 2025) in the Federal Register, nominations will be accepted for 30 days. The pre-published nomination notice can be viewed here for further details about the role of the 15-person committee, eligibility for nomination and the nomination process.
