The Final Rule for The Medicare Program

The following article on the Final Rule was published on Harmony Healthcare’s website.

In time to meet the July 31 deadline, CMS posted the Final Rule for The Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012. The Press has taken hold of one aspect of this Rule and has been reporting overall estimated payments for SNFs in FY 2012 are projected to decrease by $3.87 billion, or 11.1 percent, compared with those in FY 2011. This reflects a $600 million increase from the update to the payment rates and a $4.47 billion reduction from the recalibration of the case-mix adjustment. CMS estimates that under RUG-IV, SNFs in urban areas would experience, on average, an 11.3 percent decrease. In the Final Rule CMS points out that the FY 2012 payment rates are still 3.4 percent higher than the FY 2010 rates.  Additionally, CMS strongly states “We do not believe that the recalibration constitutes a rate cut but instead represents a return to the appropriate level of SNF payments, which have been found to be more than adequate for SNFs and small entities within the SNF industry.” CMS continues  “It is also important to note that this recalibration would serve to remove an unintended spike in payments rather than decreasing an otherwise appropriate payment amount; thus, we do not believe that the recalibration should negatively affect facilities, beneficiaries, or quality of care, or create an undue hardship on providers.”

The important information providers need to extract from this Final Rule is the clinical implications the new rules will have on patient care and retention of the Medicare Part A rate and revenue.

The Final Rule states the following changes will be instituted as of October 1, 2011:
•    Changes to the Medicare required assessment schedule.  This was not posted in the Final Rule and will need to be accessed in the Proposed Rule until the updated RAI manual is posted.
•    Allocation of Group therapy minutes equally between 4 participants.
•    Limiting Group therapy to sessions with 4 patients.
•    Plan of care for therapy must contain the rational for Group therapy.
•    EOT OMRA – Any three day break in provision of therapy services, including Rehab Low plan of treatment requires completion of an EOT – no exceptions.
•    EOT Resumption assessment to be used when therapy resumes within 5 days of the EOT OMRA at the same RUG level.
•    Eliminate the distinction between 5 day and 7 day a week therapy programs in facilities for setting the ARD for EOT OMRA.
•    Each SNF will determine for itself the appropriate manner of supervision of therapy students consistent with State and local laws and practice standards.

Therapy Center partners with nursing homes to deliver high quality, cost-effective rehabilitation services.  Our services are designed to provide our partner facilities with the highest standard of patient care, increased revenues, reduced responsibility, elimination of staffing problems and ease of compliance. Unlike staffing agencies, Therapy Center welcomes the responsibility of operating and managing a profit-generating rehabilitation department for our partner facilities. We provide highly skilled therapists and a full spectrum of rehabilitation services including physical therapy, occupational therapy, speech therapy and more. Our goal is to enhance clinical outcomes while maximizing financial reimbursements for our partner facilities.

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Kristi Fredieu

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