AARC Wins Higher Salary Equivalency Rates from HCFA

March 31, 1998
HCFA has postponed the effective date of the new salary equivalency rates to April 10, 1998.

February 4, 1998
The AARC registered a win for the profession when the Health Care Financing Administration posted final salary equivalency rates on January 30. These new rates will be effective for services funished on or after April 1, 1998.

Last March HCFA issued proposed salary equivalency rates, the rate at which Medicare reimburses for the services of a respiratory care practitioner in a SNF. At that time the AARC provided comments on those proposed regulations saying that the rates were not high enough.

In the final regulations issued on Jan. 30, the approved rate reflects an increase of about 10% over the current national hourly guideline for respiratory therapists. Increases were made to the proposed rates in all localities, with a national average rate of $40.01. In the proposed regulations the national average was $38.51.

When the proposed rates were promulgated, the AARC expressed concerns about three aspects of the rules:

• The compression of the registered respiratory therapist (RRT) and the certified respiratory therapy technician (CRTT) professionals with non-credentialed workers into one generic category of "respiratory therapy."
• The methodology and data sources used to determine the proposed respiratory therapy salary equivalencies.
• The disregard of added costs imposed by respiratory therapy's unique Medicare transfer relationship between a hospital and a skilled nursing facility (SNF).

  These new rates will be in effect until prospective payment for skilled nursing services comes on line on July 1, 1998. Be aware that the guidelines do not clearly state the amount to add on to supervisory roles. However, an AARC member contacted the HCFA staff for an explanation. They said the Medicare Providers Reimbursement Manual states that it is up to the discretion of the Fiscal Intermediary (FI) to decide how much additional reimbursement to pay for supervisory roles. Most FIs are allowing 25% of the Salary Equivalency rate. However, Blue Cross of California has decided on a mere 15% add on. That decision is being appealed.

  The final salary equivalency guidelines are published beginning on page 5105 of the January 30 Federal Register or are available online in pdf format. You must have the Adobe Acrobat Reader to view this file.

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  Medicare Salary Equivalency Guidelines

  January 1998
  The AARC provided comments on the proposed Salary Equivalency Guidelines issued by Health Care Financing Administration (HCFA). The proposed guidelines, to cover physical therapy, speech language pathology, occupational therapy, and respiratory therapy were published in the March 28, 1997 Federal Register.

  AARC expressed concerns about three aspects of the proposed rules:

  1. The compression of the registered respiratory therapist (RRT) and the certified respiratory therapy technician (CRTT) professionals with non-credentialed workers into one generic category of "respiratory therapy."
  2. The methodology and data sources used to determine the proposed respiratory therapy salary equivalencies.
  3. The disregard of added costs imposed by respiratory therapy's unique Medicare transfer relationship between a hospital and a skilled nursing facility (SNF).

  In a letter to Bruce Vladeck, former HCFA administrator, from 1997 AARC president Kerry George, the AARC went on record as opposing the adoption of the salary equivalency guidelines.

  In commenting on the single level respiratory therapy category, George said, "The single category does not account for the higher level of compensation an RRT receives, nor the propensity for SNF's to utilize the advanced RRT practitioner with experience."

  In addition, the methodology used to determine salary equivalency rates for all of the therapy professions does not represent an equitable calculation. "The Medicare transfer agreement requirement limits the efficiency of providers in contracting for respiratory therapy services; a unique set of circumstances not faced by other therapy professions," said George. "This must be addressed in the regulation."

  More information on salary equivalencies is available online in the 1997 Federal Register.