SNF Reimbursement changes- be in the know

1. New payment models went into effect on October 1, 2019 which changed the payment model from a RUG-IV, Resource Utilization Group to a PDPM, Patient Driven Payment Model.

-The RUG-IV payment model is calculated using a case mix of therapy plus nursing services. Reimbursement for therapy is contingent of the time of therapy services provided; not the outcome or not the need.

-The new proposed PDPM model is based on a case mix of PT, OT, SLP, nursing, and ancillary service. Payment is no longer determined by the volume of services provided, but by the medical needs of the patient.

2. New payment models mean that SNF’s are no longer paid separately for therapy services provided.

- SNF’s will earn a financial incentive if quality outcomes are met at the end of the year. This is intended to assure patients continue to receive the services that are medically necessary for to achieved goals.

3. Therapists are feeling the impact of the changes through layoffs.

In an article posted by Modern Health Care, Genesis Healthcare has reportedly laid off 585 therapists since the October 1 effective date. There are additional reports by therapists of pressure to provide services in a group setting or to be transitioned to a per diem status.

CMS will be monitoring utilization changes among SNF’s, and a substantial change in the provision of services may result in a medical review.

What does this imply about the services being provided prior to October 1??

4. Group and concurrent therapy are now expected to be provided as a component of therapy services but is restricted to 25 percent of the total therapy hours.

- Prior to October 1, 2019, group therapy services are reported to be 1% of all therapy services provided in the SNF. They are currently expected to increase with the changing reimbursement and changing requirements of group therapy. The definition for group therapy has been revised to include between 2-6 patients, depending on therapist discretion. Group and concurrent services cannot exceed 25% of total therapy services provided. Non-compliance with this requirement can lead to a Medicare review and potential take back.

The therapy profession is facing many changes in the next few years that are affecting reimbursement and jobs. Stay tuned for continued updates on changes to keep you in the know