Medical rehabilitation focuses on improving or restoring functional independence for individuals with disabilities resulting from injury, illness or a medical condition.
Medical rehabilitation is provided at all levels of the health care continuum, including general acute-care hospitals, inpatient rehabilitation facilities (IRFs), skilled-nursing facilities, long-term-care hospitals, outpatient programs and home health agencies.
The Division of Workers’ Compensation (DWC) has published the final regulations pertaining to the revised physician fee schedule (PFS), which became effective Jan. 1. The PFS also covers services of non-physician practitioners, such as physical therapists, occupational therapists, nurse practitioners, physician assistants, clinical social workers, clinical nurse specialists, nurse anesthetists and anesthesiologist assistants. The new PFS is based on the resource-based relative value scale system used by Medicare.
The new system implements the Medicare Multiple Procedure Payment Reduction (MPPR) on physical, occupational and speech therapy services. In addition, it applies various caps on the number of procedures that are reimbursable during a single therapy visit, requiring a written, pre-negotiated fee arrangement if the caps are exceeded. The final regulations are attached, as well as a list of procedures subject to the MPPR. For additional information, visit www.dir.ca.gov/dwc/OMFS9904.htm#6.
To clarify coverage policies following a recent settlement agreement, the Centers for Medicare & Medicaid Services (CMS) has revised portions of its Medicare Benefit Policy Manual on services provided by skilled-nursing facilities, inpatient rehabilitation facilities, home health agencies and outpatient therapy. Based on the settlement agreement, Jimmo v. Sebelius, CMS Transmittal 176 specifies that standards requiring potential for improvement may not be applied as a rule of thumb to determine Medicare coverage for services that require skilled-nursing care or skilled therapy services. It also provides guidance on appropriate documentation. CMS notes that the transmittal, attached, does not represent an expansion of benefits or a change in Medicare’s longstanding policy on the need for skilled-nursing care and skilled-therapy services.
The Centers for Medicare & Medicaid Services (CMS) has updated its frequently asked questions (FAQs) document regarding therapy services functional reporting. The document, attached, provides information about CMS coverage for physical therapy, occupational therapy, and speech/language pathology services.
Recordings of recent conference calls held by the Centers for Medicare & Medicaid Services on the quality reporting programs for inpatient rehabilitation facilities (IRFs) and long-term-care hospitals (LTCHs) will be available July 30 through Aug. 1. Facilities may access the calls by dialing (855) 859-2056, and using conference IDs 13189170 for IRFs and 13198135 for LTCHs. As mandated by the Affordable Care Act, IRF and LTCH quality reporting programs will begin Oct. 1.
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule regarding the inpatient rehabilitation facility (IRF) quality reporting program (QRP). The proposed rule was included in the calendar year 2013 hospital outpatient prospective payment system (OPPS) proposed rule issued July 6. CHA’s “first-glance” summary of the OPPS and IRF QRP proposed rules is available at www.calhospital.org/cy2013-opps-proposed-first-glance. In the coming weeks, CHA will issue a more detailed summary of the proposed rule, and will work with members to develop comments for submission to CMS. Comments are due Sept. 4 at 2 p.m. (PT).