Skip to main content

It's final: the US Centers for Medicare and Medicaid Services (CMS) is moving ahead with a rule governing skilled nursing facilities (SNFs) that's almost identical to what it proposed in April, including a change advocated for by APTA—a revised definition of what constitutes "group therapy" in SNFs. Aside from that alteration, it's a rule that hews to CMS' original plans to dramatically change the payment system for SNFs.

As anticipated, the final rule proceeds with implementation of the Patient-Driven Payment Model (PDPM). The model is based on a resident's classification among 5 components (including physical therapy) that are case-mix adjusted, and employs a per diem system that adjusts payment rates over the course of the stay. APTA has developed a number of resources on PDPM.

Other notable elements of the final rule:

  • In a win for APTA and its members, CMS moved away from a rigid 4-person definition and adopted the association's recommendation that the definition of group therapy as 2 to 6 patients doing the same or similar activities—the same definition used in inpatient rehabilitation settings.
  • The final rule adopts a "subregulatory" process to keep up with nonsubstantive updates to the ICD-10 codes used in PDPM, while substantive changes will be made through the traditional notice-and-comment rulemaking process.
  • CMS will implement 2 new quality measures—transfer of health information to the provider-post-acute-care, and transfer of health information to the patient-post-acute-care—to be provided by the SNF at the time of transfer or discharge.
  • The rule also adopts a number of standardized patient assessment data elements that assess cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidities; impairments; and social determinants of health.
  • CMS projects aggregate payments to SNFs will increase by $851 million, or 2.4%.

PT in Motion News covered the PDPM in detail when the rule was proposed. Since that time, APTA has launched an education campaign on the new system that includes a webpage on PDPM.


You Might Also Like...

Review

Proposed FY '24 SNF and IRF Rules: Payment Increases and Few Surprises

Apr 12, 2023

Each facility type could see a 3.7% payment increase, with CMS holding off on implementing several potentially problematic ideas.

Article

Study: 'Profit-Maximizing' SNFs Were Quick to Decrease Staffing After PDPM

Jan 17, 2023

Researchers analyzed the effects of the Patient-Driven Payment Model payment system — and the pandemic — on therapy staffing in SNFs.

Review

Proposed FY 2023 SNF Rule: CMS Makes Good on Threat to Enact Cuts

Apr 14, 2022

CMS says it's because the PDPM payment system isn't working out as planned. Some of the pain will be softened by cost-index adjustments.