FY2014 Medicare SNF Proposed Revisions are Limited

June 17, 2013

The Centers for Medicare & Medicaid Services (CMS) released proposed rules for skilled nursing facilities (SNFs) that affect the documentation of Part A therapy treatment time. This policy revision proposal, effective October 1, 2013, would require that distinct calendar days of treatment be recorded in the Minimum Data Set (MDS) in addition to the current requirement of treatment minutes.

For the coming fiscal year, CMS estimates that aggregate payments to SNFs will increase by about 1.4%, or $500 million, for Part A services. This figure is based on a market basket inflation increase and certain downward adjustments required by law. CMS also reports in the proposed rule that facilities in fiscal year (FY) 2012 reported a decrease in group therapy. ASHA predicted this reduction based on rules initiated October 1, 2011, that penalized each resident's group therapy minutes if fewer than four patients participated.


SNF Part A is governed by a prospective payment system (PPS) and does not include Part B services for which patients qualify after exhausting their Part A benefit. Since 1998, only treatment minutes per week have been required in the MDS, which made enforcement of the requirements for therapy (3x per week or 5x per week) difficult to verify without a tedious review of patient records. The day-of-service identification is expected to be implemented by a revision of the MDS form.

CMS continues to research potential alternatives to the existing methodology used to pay for therapy services rendered under SNF PPS. Payment rates are currently based on therapy provided to a patient during a 7-day look-back period. In the proposed rule, CMS announced contracts with Acumen, LLC and the Brookings Institution to look at options for improving or replacing the current payment system. Comments on the existing payment methodology are welcomed by CMS at SNFTherapyPayments@cms.hhs.gov. CMS will be regularly updating the public on the progress of this project on the CMS website. The complete proposed rule appears in the May 6, 2013, Federal Register [PDF], with comments due July 1, 2013.

ASHA would appreciate copies of comments submitted by members regarding the SNF PPS or alternative payment methodologies to be sent to mkander@asha.org.

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For more information, please contact Mark Kander, ASHA's director of health care regulatory analysis, by e-mail at mkander@asha.org.

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