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  • What's Up at CMS? Here's a Quick Rundown of 5 Rules That May Affect You

    Spring is gone, summer's here, and the US Centers for Medicare and Medicaid (CMS) just keeps on churning out more proposed and final rules that can have a big impact on physical therapists (PTs) and physical therapist assistants (PTAs). Sometimes the changes will be felt directly by PTs and PTAs; sometimes the changes affect how employers will operate; sometimes the changes have to do with the ways beneficiaries interact with the systems.

    The regulatory affairs staff at APTA keeps a close eye on all of the rulemaking and creates detailed resources that can keep you up to speed. It's all part of an effort to untangle rules that can seem dizzingly complex—but should not be ignored.

    Here are 5 rules you should know about—4 proposed and 1 final—and what APTA offers for a more detailed take.

    Acute care hospitals and long-term care hospitals (proposed rule)
    Quick take:
    The IMPACT Act signed into law last year is sparking some significant changes around the kind of data long-term care facilities gather and report, with emphasis on standardized quality reporting across the different types of postacute care facilities—long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. CMS estimates that Medicare spending on inpatient hospital services will increase by about $120 million in FY 2016.
    Available from APTA: summary and highlights, comments to CMS

    Skilled nursing facility (SNF) prospective payment system (proposed rule)
    Quick take:
    CMS is proposing an increase in payments to SNFs, and also implementing a SNF quality reporting program by 2018. Again, the IMPACT Act plays a big role in the proposal, with requirements for new quality measures for the SNF quality reporting program. Also worth noting—new rules on mandatory reporting about staffing, including hours worked and employee turnover.
    Available from APTA: summary and highlights, comments to CMS

    Inpatient rehabilitation facility (IRF) prospective payment system (proposed rule)
    Quick take:
    IRFs will receive an average overall estimated increase of 1.7% in 2016. Like other postacute care settings, IRFs would be subject to increased quality reporting requirements for quality domains identified in the IMPACT Act. CMS also proposes 4 additional functional status measures for IRFs.
    Available from APTA: summary and highlights, comments to CMS

    Medicaid Managed Care Organizations (proposed rule)
    Quick take:
    The first major change proposed to Medicaid in a dozen years, the rule is described by Health Affairs as "a defining moment" for the program. The rule takes aim at how Medicaid managed care plans can market to consumers, and how the plans can be integrated with the health care exchanges developed through the Patient Protection and Affordable Care Act (ACA). The proposal, which also affects the Children's Health Insurance Plan (CHiP), would increase program integrity and quality improvement requirements.
    Available from APTA: summary and highlights (comments under development)

    Medicare Accountable Care Organizations (ACO) (final rule)
    Quick take:
    The final CMS rule on Medicare ACOs includes more flexibility for the care networks, which now number nearly 400 and serve an estimated 7 million beneficiaries. Among other changes, the rule opens up a "third option" for ACOs that involves taking on more risk in exchange for the potential to keep more money linked to savings. The new rule also opens up the possibility for ACOs to avoid penalties beyond the 3-year timeframe previously established by CMS,
    Available from APTA: summary and highlights of final rule

    Plus: Stay tuned for one of the year's most-anticipated rules—the CMS proposal for next year's physician fee schedule, likely to be released on or around July 1. Also due to drop soon: proposed rules on home health and outpatient hospitals. APTA will review all proposed rules and create a highlights resource, as well provide comments to CMS.


    • I've been reading about the IMPACT act of 2014 on Centers for Medicare and Medicaid Services website for several months. Although it provides "tremendous" opportunity to deal with the priorities and upholding their Quality Strategy goal, I can't still see the point of this idea: "discharge to community." So what does this mean? I am currently a supporter of privatized long term care insurance; even I could care less about the proposal for standardized data. It is still my concern to probe more on the areas that we barely talk about. If it's really clear, I won't mind asking this stuff. But I hope that it's similarly understandable as this one https://www.infolongtermcare.org/long-term-care-insurance-information/ so others can know easily this “uniform” data thingy.

      Posted by InfoLTC on 7/3/2015 3:49 AM

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