Released yesterday by the Centers for Medicare and Medicaid Services (CMS), the nursing facility (SNF) prospective payment system (PPS) proposed rule for Fiscal Year 2012 contains 2 recommendations of significance to physical therapists—changes relating to the payment of group therapy services and the supervision of therapy students.
Specifically, CMS proposes to establish a standard that defines group therapy as therapy provided simultaneously to 4 patients who are performing similar therapy activities. The agency states that when a therapist treats 4 patients in a group for an hour, it does not cost the SNF 4 times the amount (or 4 hours of a therapist's salary) to provide those services. Therefore, if a therapist spends 1 hour with 4 residents in a group therapy session, regardless of payer source, then the time used to determine the appropriate Resource Utilization Groups, version 4 (RUG-IV) classification for each Medicare beneficiary receiving SNF care benefits as part of a qualified Part A stay, will be 15 minutes, or 60 minutes of total therapist time divided by 4.
Regarding students, CMS proposes to revise its current policy such that a therapy student working in a SNF would no longer be required to be in the supervising therapist's line of sight. The agency invites comments on this proposed revision and states that it will continue to monitor the provision of therapy services in the SNF setting.
CMS also examines recent changes in provider behavior relating to the implementation of the RUG-IV case-mix classification system and considers a possible recalibration of the case-mix indexes so that they more accurately reflect parity in expenditures between RUG-IV and the previous case-mix classification system. The proposal also includes a discussion of a non-therapy ancillary component and outlier research currently under development within CMS.
APTA is currently reviewing the proposed rule and will provide a detailed summary in the coming week.