An overhaul to Medicare’s payment system for beneficiaries in skilled nursing facilities—which would use patients’ clinical characteristics, such as diagnoses and other factors—is scheduled to take place Oct. 1, 2019.
The proposed rule from the Centers for Medicare and Medicaid Services (CMS) would eliminate Medicare Part A (inpatient) payment for skilled nursing facilities (SNFs) based on the amount of therapy the beneficiary receives.
Under the proposal, a SNF would receive payment for physical therapy, occupational therapy, and/or speech-language pathology services based on the patient’s diagnosis and other characteristics. Previously, SNFs received a payment for general therapy based on the number of therapy minutes provided. CMS research indicates that in addition to the patient’s primary diagnosis (usually acute neurologic conditions), the need for speech-language services related to a swallowing disorder, a mechanically altered diet, a comorbidity related to speech-language disorders, and/or cognitive impairment warrants additional payments.
Various combinations of these characteristics produce 12 speech-language pathology case-mix groups. For example, if a patient has an acute neurologic condition, a comorbidity related to a speech-language disorder, a cognitive impairment, a swallowing disorder and a mechanically altered diet, reimbursement for that patient would be higher than for a patient with “only” an acute neurologic condition and swallowing disorder. However, the SNF would receive payment for speech-language pathology services for both of these patients.
The proposed rule also includes:
• A 25-percent cap on the use of group and concurrent therapy for a patient.
• The inclusion of mechanically altered diets as a need for increased speech-language pathology services, a characteristic ASHA had requested.
• The inclusion of an ASHA recommendation to use Section O of the Minimum Data Set (MDS) to track a patient’s therapy and to ensure compliance with the group and concurrent therapy cap.
• Required assessments only at admission, discharge, and an “interim payment assessment” as needed.
CMS will entertain comments on the proposed rule, and is expected to announce a final rule later this summer.
Sarah Warren, MA, is ASHA director of Medicare policy. firstname.lastname@example.org