• Thursday, August 01, 2013RSS Feed

    2014 Prospective Payment System Raises SNF and IRF Payments

    The 2014 prospective payment system (PPS) final rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) call for market basket updates of 1.3% and 2.3% respectively. The Centers for Medicare and Medicaid Services (CMS) released the final PPS rules for these facilities July 31, and the Federal Register will publish both rules August 6.

    Also for SNFs, an item is added to the Minimum Data Set to permit SNFs to record the number of distinct calendar days of therapy provided by all rehab disciplines—physical therapy, occupational therapy, and speech-language pathology—over the 7-day look-back period. The final rule clarifies that classification into the Medium Rehab category requires 5 distinct calendar days of therapy, and classification into the Low Rehab category requires 3 distinct calendar days.

    For IRFs, the rule revises the list of diagnosis codes that may be counted toward the threshold to determine "presumptive compliance" (the "60% Rule"), removing nonspecific, arthritis, unilateral upper extremity, some congenital anomaly, and miscellaneous diagnosis codes. However, in response to stakeholder comments regarding implementation of these changes, the effective date is delayed for 1 year. Therefore, these codes will be removed for compliance review periods beginning October 1, 2014.

    Under the IRF Quality Reporting Program, CMS adopts the following quality measures:

    • NQF-endorsed version of the Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (Short-Stay)
    • Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short-Stay)
    • Influenza Vaccination Coverage among Healthcare Personnel
    • All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities

    Both final rules become effective October 1, 2013. APTA will analyze them and provide summaries in the coming weeks.


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