Skilled Nursing Facilities (SNF)

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The Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) requires submission of standardized assessment data by Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs). The assessment categories include functional status, cognitive function/mental status, special services, treatments, and interventions, medical conditions/co-morbidities, and impairments. In its FY 2018 SNF payment updates, CMS has proposed a respiratory grouping under the “services, treatments, and interventions” category to include continuous and intermittent oxygen, suctioning, tracheostomy care, invasive/non-invasive mechanical ventilation. Working with members of AARC’s Long Term Care Section, AARC submitted comments and recommendations, on the various respiratory categories. However, based on a significant number of public comments, CMS has chosen not to finalize three of the five data elements, one of which is the respiratory special services category due to concerns of an increased reporting burden, the need to hire additional resources, having to update protocols and systems and train staff. The two data elements that were finalized include functional status and medical conditions/co-morbidities. Because the data elements are not effective until FY 2020, that is, for SNF admissions and/or discharges occurring between October 1, 2018 and December 31, 2018, CMS intends to conduct a national field test to consider the best way to move forward taking into account the time it would take SNFs to prepare for the reporting requirements. They plan to publish new proposed rules with respect to the categories they put on hold, so AARC will have additional opportunities to comment in the future.

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In additional to the requirement for standardized resident assessment data, each year CMS proposes updates to the SNF prospective payment rates. In the SNF setting, respiratory therapy is considered a non-therapy ancillary service (NTAS) and charges for such services are included as part the nursing component. In the FY 2018 SNF update, CMS acknowledges the current methodology does not adequately provide for payments that account for variation in, or the real costs of, NTAS such as drugs, laboratory services, respiratory therapy, medical supplies, prescription drugs and medication therapy. CMS has proposed to make changes to the payment methodology to improve the situation. The new proposed methodology consists of conditions/extensive services to which points would be assigned based on resource use, resulting in six categories ranging in points from 0 to 11+. Those dealing with respiratory issues include the following: Ventilator/Respiratory (High), Cystic Fibrosis (Medium), Multiple Sclerosis (Medium), Tracheostomy (Medium), Asthma, COPD or Chronic Lung Disease (Medium), and Suctioning (Low). AARC submitted comments in support of the methodology and made recommendations to ensure it adequately addressed resource use and time with respect to respiratory issues. Because the comment period was extended to August 25, 2017, these rules have not yet been finalized.