Medicare Proposes SNF Payment Overhaul An overhaul to Medicare’s payment system for beneficiaries in skilled nursing facilities (SNFs)—which would be based on patients’ clinical characteristics, such as diagnoses and other factors—is scheduled to take effect Oct. 1, 2019. The proposed rule from the Centers for Medicare and Medicaid Services (CMS) would replace the current system ... News in Brief
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News in Brief  |   July 01, 2018
Medicare Proposes SNF Payment Overhaul
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Special Populations / Older Adults & Aging / Healthcare Settings / Practice Management / News in Brief
News in Brief   |   July 01, 2018
Medicare Proposes SNF Payment Overhaul
The ASHA Leader, July 2018, Vol. 23, 9. doi:10.1044/leader.NIB4.23072018.9
The ASHA Leader, July 2018, Vol. 23, 9. doi:10.1044/leader.NIB4.23072018.9
An overhaul to Medicare’s payment system for beneficiaries in skilled nursing facilities (SNFs)—which would be based on patients’ clinical characteristics, such as diagnoses and other factors—is scheduled to take effect Oct. 1, 2019.
The proposed rule from the Centers for Medicare and Medicaid Services (CMS) would replace the current system for Medicare Part A (inpatient) payment to SNFs, which is based on the amount of therapy the beneficiary receives.
Under the proposal, an 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 and discharge, and an “interim payment assessment” as needed.

CMS will review comments on the proposed rule, and is expected to announce a final rule later this summer.
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July 2018
Volume 23, Issue 7