CMS Releases Medicare Rules Affecting Occupational Therapy
This week, Centers for Medicare & Medicaid Services (CMS) released final rules dealing with payment rate and policies in skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), acute care and long-term care hospitals, and hospice.
The following summary provides you with general information about changes in the SNF and IRF rules, which have a significant impact on occupational therapy services. AOTA is currently analyzing these final rules and will provide a detailed analysis shortly.
SNF Prospective Payment System (PPS)
In addition to recalibrating and updating the SNF PPS payment rates for FY 2010, this final rule:
- Establishes a revised case-mix classification methodology (RUG-IV) and implementation schedule for FY 2011, reflecting updated staff time measurement data derived from the recently completed Staff Time and Resource Intensity Verification (STRIVE) project.
- Includes information on the transition to the Minimum Data Set, Version 3.0 (MDS 3.0) redesigned nursing home resident assessment instrument, including an implementation schedule.
- Changes policy for concurrent therapy practice limiting the number of patients treated concurrently to two, requires that the minutes of therapy be allocated to each patient treated, and that the mode of therapy (individual, concurrent, or group) be denoted on the MDS.
- Discusses comments CMS received on a possible new rate component to account for the use of non-therapy ancillaries (as recommended by MedPAC), and on a possible new requirement for the quarterly reporting of nursing home staffing data.
In addition to updating the IRF PPS payment rates for FY 2010, the specific coverage requirements that are adopted in the final rule include:
- Require as admission criteria that the patient is able and willing to actively participate in an intensive rehabilitation program and is expected to make measurable improvement in his or her functional capacity or adaptation to impairments.
- Require that IRF services be ordered by a rehabilitation physician with specialized training and experience in rehabilitation services and be coordinated by an interdisciplinary team—including at least a registered nurse with specialized training or experience in rehabilitation, a social worker or case manager (or both), and a licensed or certified therapist from each therapy discipline involved in treating the patient. The rehabilitation physician would be responsible for making the final decisions regarding the patient’s treatment in the IRF.
- Require a post-admission evaluation to document the status of the patient after admission to the IRF, and require comparison of this post-admission screen and the preadmission screening documentation. Using this information, facilities can begin developing an overall plan of care that is designed to meet the individual patient’s specific needs. The rule requires the maintenance of the overall plan of care in the patient’s medical record. However, in response to comments, the final rule extends the deadline for completing the overall plan of care to the end of the fourth day following the patient’s admission, rather than the proposed rule’s deadline of 72 hours. Also in response to comments, the final rule does not require the rehabilitation physician to consult with the interdisciplinary team members when developing the post-admission evaluation, although the rule encourages the rehabilitation physician to consider any available input from the interdisciplinary team members.
- Require that IRFs use qualified personnel to provide required rehabilitation nursing, physical therapy, occupational therapy, speech-language pathology, social services, psychological services, and prosthetic and orthotic services.
- Require the interdisciplinary team to meet weekly to review the patient’s progress and make any needed modifications to the individualized overall plan of care.
In addition, a proposed rule impacting home health payment was also released (the deadline for comments is September 28, 2009) Also, the proposed rule governing services reimbursed under the Medicare Physician Fee Schedule was released earlier this month. Comments are due to CMS on August 31, 2009. Read AOTA’s summary of the proposed Medicare Physician Fee Schedule and send your feedback to AOTA at firstname.lastname@example.org if you have a position on relevant issues covered.
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