• Friday, August 01, 2014RSS Feed

    SNF, IRF Final Rules for 2015 Released by CMS

    Rule changes for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) will increase payments by 2% and 2.2%, respectively in 2015. In addition to the increases, the new rules issued from the Centers for Medicare and Medicaid Services (CMS) will make changes to a host of reporting, coding, and data collection models, as well as establish definitions of various therapy models in IRFs.

    The payment increases amount to an additional $750 million for SNFs, and an increase of $180 million for IRFs.

    IRF rules changes (.pdf) include the following:

    • Removal of 10 status post-amputation diagnoses codes from the list of codes that meet presumptive compliance criteria
    • Beginning October 1, 2015, addition of an item in the IRF patient instrument (PAI) to record the amount and mode of therapy delivered by each therapy discipline for the first 2 weeks of the IRF stay
    • Creation of definitions for "individual therapy," "co-treatment," "concurrent therapy," and "group therapy" in an effort to align with current SNF Part A definitions
    • Addition of a yes/no check off in IRF-PAI that would indicate whether prior treatment and severity requirements have been met for patients with arthritis
    • Addition of IRF quality reporting measures that would include outcome measures related to MRSA and clostridium difficile infection (CDI)

    The final rule changes for SNFs (.pdf) involve a provision that will allow SNFs to use a change of therapy (COT) other Medicare required assessment (OMRA) to reclassify residents formerly but not currently in a therapy resource utilization group (RUG) into a new RUG. CMS will continue to prohibit the use of the COT OMRA for initial classification of patients into a therapy RUG.

    Additionally, the SNF final rule includes a statement from CMS that acknowledges the comments it received around the development of an alternative therapy payment model. The agency states that several models are being explored, and that the changeover to a new model must be timely and incorporate stakeholder feedback that addresses problems in the current SNF payment structure. CMS has not set a date for implementation and is still accepting input on the issue.

    APTA will post a detailed summary of the rules in the coming weeks.

    Want to find out exactly how these rules changes will affect your practice setting? Attend APTA’s Postacute Care Compliance Seminar on November 15, 2014.


    Leave a comment
    Name *
    Email *
    Homepage
    Comment

  • ADVERTISEMENT