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The Centers for Medicare and Medicaid Services (CMS) released 2006 updates for skilled nursing facility (SNF) per diem payment rates for Part A stays which includes an overall annualized increase of 3% in Medicare aggregate spending (Federal Register, August 4, 2005). The rate change is effective January 1, 2006 instead of the usual October 1 to allow ample time for the facilities to adjust to a refined Resource Utilization Group (RUG) case-mix classification system.
The current 14 rehabilitation-intensive RUGs (each of which has 3 payment levels) experience rate increases of 3 to 8% for urban settings. For rural settings the rehabilitation RUG increase is a consistent 3.2%. A resident who requires at least 500 minutes of therapy per week will yield a daily payment ranging from $329 to $385 (urban setting), depending on the resident’s activities of daily living (ADL) rating. The increase in value of the rehabilitation-intensive RUGs is due to moderate increases in the therapy component and greater increases in the nursing component. However, the SNF is free to allocate the total per diem amount as it sees fit for direct patient services and overhead.
An expansion of RUG categories from 44 to 53 is finalized, creating nine new categories that describe residents needing rehabilitation services in combination with extensive medical services. The “extensive services” category is determined by the need for intravenous medication, suctioning, tracheostomy care or use of a ventilator/respirator.
ASHA’s comments supported the retention of the current allowance of three grace days added to a SNF resident’s 5-day assessment period. Grace days allow rehabilitation professionals to more accurately estimate the amount of therapy required and maintain efficiency in staffing by not requiring rehabilitation staff to be on call for weekend assessments. CMS agreed to delay the decision regarding grace days and include the issue as part of the design process for the revised Minimum Data Set and revision of the case-mix classification system
CMS continues to raise the issue of concurrent therapy. This involves a single therapist treating more than one Medicare patient at a time, rendering unrelated services, unlike group therapy. CMS reports that some therapists are pressured by management to render concurrent therapy when clinically inappropriate. CMS agreed to collaborate with professional organizations to establish guidelines and develop educational materials to better define appropriate concurrent therapy. For further information, please contact Mark Kander, ASHA’s Director of Health Care Regulatory Analysis, at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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