The Centers for Medicare & Medicaid Services (CMS) recently released its 232-page proposed rule to update the Medicare skilled nursing facility (SNF) prospective payment system (PPS) for federal fiscal year (FY) 2020, which begins on October 1, 2019. Overall, CMS projects that SNF PPS payments would rise by $887 million under the proposed rule. Specifically, CMS proposes a 2.5% increase factor, based on a SNF market basket update of 3.0% reduced by a 0.5 percentage point multifactor productivity adjustment.
As we have reported previously, FY 2020 will mark the implementation of the new Patient-Driven Payment Model (PDPM) first announced during last year’s SNF PPS rulemaking cycle. PDPM focuses on a resident’s clinical condition and care needs rather than the volume of care provided. In structuring PDPM last year, CMS finalized a combined 50% limit on group and concurrent therapy furnished to a SNF resident, such that for each therapy discipline (i.e., physical therapy, occupational therapy, and speech-language pathology), no more than 25% of the therapy services furnished to a SNF resident during a covered Medicare Part A stay may be in a group or concurrent setting. At the time, CMS stated that it intended to define group therapy as exactly four residents performing the same or similar therapy activities.
Now, however, CMS proposes that group therapy would include treating at the same time two to six residents who are performing the same or similar activities. CMS states that it believes this proposed change “would offer therapists more clinical flexibility when determining the appropriate number for a group, without compromising the therapist’s ability to manage the group and the patient’s ability to interact effectively and benefit from group therapy.” Nevertheless, the proposed rule cautions that CMS continues to believe that “individual therapy is the preferred mode of therapy provision and offers the most tailored service for patients.” Moreover, CMS emphasizes that
when group therapy is used in a SNF, therapists must document its use in order to demonstrate why it is the most appropriate mode of therapy for the patient who is receiving it. . . . SNFs should include in the patient’s plan of care an explicit justification for the use of group, rather than individual or concurrent, therapy. This description should include, but need not be limited to, the specific benefits to that particular patient of including the documented type and amount of group therapy; that is, how the prescribed type and amount of group therapy will meet the patient’s needs and assist the patient in reaching the documented goals.
CMS will accept comments on the proposed rule until June 18, 2019. A final rule is expected to be published on or before August 1, 2019.