Nursing Facilities Face New Medicare Restrictions Medicare payments to skilled nursing facilities will be reduced by 11.1% in 2012, according to final regulations released July 29 for Part A services in skilled nursing facilities (SNFs). According to the Centers for Medicare and Medicaid Services (CMS), this considerable rate decrease is due substantially to higher-than-expected use of ... Bottom Line
Free
Bottom Line  |   September 01, 2011
Nursing Facilities Face New Medicare Restrictions
Author Notes
  • Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.
    Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.×
Article Information
Special Populations / Older Adults & Aging / Healthcare Settings / Practice Management / Professional Issues & Training / Regulatory, Legislative & Advocacy / Bottom Line
Bottom Line   |   September 01, 2011
Nursing Facilities Face New Medicare Restrictions
The ASHA Leader, September 2011, Vol. 16, 8. doi:10.1044/leader.BML3.16112011.18
The ASHA Leader, September 2011, Vol. 16, 8. doi:10.1044/leader.BML3.16112011.18
Medicare payments to skilled nursing facilities will be reduced by 11.1% in 2012, according to final regulations released July 29 for Part A services in skilled nursing facilities (SNFs).
According to the Centers for Medicare and Medicaid Services (CMS), this considerable rate decrease is due substantially to higher-than-expected use of therapy payment categories in the first eight months of fiscal year 2011. The overpayments were detected using claims and assessment data and have been confirmed since publication of the proposed regulation in April.
Other major regulatory changes affecting speech-language pathologists include supervision of graduate students, restrictions on group treatment, and more restrictive rules for missed treatments. The final rule is available online [PDF].
Student Supervision
CMS had proposed removing specific student supervision restrictions for SNF Part A patients. The change would match the absence of student supervision regulations in hospitals and achieve conformity among inpatient settings. In its regulatory comments, ASHA proposed guidelines for student supervision generally shared by other professional therapy associations. These guidelines call for the supervising speech-language pathologist to determine a student’s ability to practice independently or the appropriate amount of supervision needed based on the student’s knowledge, experience, and competence.
However, CMS stood by its proposal, concluding that speech-language pathology (and occupational and physical therapy) students require supervision, allowing each SNF to “determine for itself the appropriate manner of supervision of therapy students consistent with applicable state and local laws and practice standards.” CMS emphasized that the change would in no way alter the student’s basic status as operating under the clinician’s supervision and that “the time the student spends with a patient will continue to be billed as if it were the supervising therapist alone providing the therapy.”
Even in the absence of regulatory mandate, most SNF administrators are likely to allow supervising SLPs to adhere to ASHA’s proposed guidelines.
Group Treatment
Despite ASHA’s protest, CMS retained its group treatment proposal in the final regulations. CMS defines group treatment as requiring four persons; if fewer than four are scheduled to participate, the session may not be categorized as group treatment.
For reimbursement purposes, the total group treatment minutes are divided by four, regardless of how many patients actually take part. Under this new regulation, if only two or three participants are able to take part in a scheduled four-person group treatment session, the SLP may assign only 15 minutes of time (60 divided by four) to each patient for reimbursement.
In its protest, ASHA noted that no research supports the assumption that four persons is optimal and expressed concern that the proposed restriction will deter SLPs from providing group treatment. ASHA cited a recent survey indicating that when SLPs provide group treatment in SNFs, almost 76% of the groups consist of two or three participants.
Medicare continues to allow up to 25% of SNF treatment per discipline (speech-language, occupational therapy, or physical therapy) per week to be in the form of group treatment.
Assessments
The final regulation also expands the regulations for other Medicare required assessments (OMRAs). Under current regulations, patients in SNFs with seven-day treatment schedules must be discharged from treatment if they miss treatment for three days. An assessment is required for the patient to restart treatment. For example, if a patient receiving swallowing treatment received no such therapy for three days (e.g., Friday, Saturday, and Sunday), then an assessment would be required, even though the OMRA serves no purpose as a clinical management tool.
The final regulations extend this requirement to SNFs with five-day treatment schedules.
In its regulatory comments, ASHA indicated several logical reasons for missed treatment on the first or last day of a work week (e.g., patient illness, clinician illness, patient refusal, physician office visit) that could result in a three-day interruption of services, and suggested revising the OMRA requirement to four days to avoid unnecessary discharges and reassessments. CMS chose to retain the regulation in the final rule.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
September 2011
Volume 16, Issue 11