American Speech-Language-Hearing Association
July 29, 2010

Home Health, Skilled Nursing, and Inpatient Rehabilitation Facilities CMS Updates

On July 16th, the Centers for Medicare and Medicaid Services (CMS) released two notices and one proposed rule concerning home health, skilled nursing facilities, and inpatient rehabilitation facilities.

The proposed rule for home health provides a payment system update and changes to therapy coverage requirements. CMS proposes a 4.75% decrease in Medicare payments to home health agencies for calendar year 2011. CMS also proposes clarifications to home health therapy coverage requirements. Clarifications include additional documentation requirements. For example, therapy treatment goals would need to be described in the plan of care. Also, qualified therapists would need to periodically reassess a patient’s function in order to determine that the services continue to be effective.

The notice for skilled nursing facilities contains an increase in payment rates of 1.7% for fiscal year 2011. CMS also discusses a self-implementing provision in the Patient Protection and Affordable Care Act (PPACA) that modifies for fiscal year 2011 the implementation schedule for the Resources Utilization Group, version 4 (RUG-IV) case-mix classification system that CMS announced last year. CMS will delay implementation of the provision until it completes system modifications.

In the notice for inpatient rehabilitation facilities, CMS proposes a market basket increase factor of 2.5%, offset by .25% as required by PPACA. This would result in an increase of payments to inpatient rehabilitation facilities in 2011 of $135 million.

For additional information, please contact reimbursement@asha.org.


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