Healthcare News: CMS releases FY 2014 proposed rules for SNFs and IRFs

CMS has had a couple of busy months releasing various FY 2014 proposed rules. On May 1, CMS issued its proposed rule for skilled nursing facilities (SNF). On May 2, the agency issued its proposed rule for inpatient rehabilitation facilities (IRF). The two rules come in the wake of the IPPS proposed rule issued April 26.

The proposed rule for SNFs increases Medicare payment rates by 1.4% ($500 million) in FY 2014. In addition, CMS proposes to:
  •  Revise and rebase the marketbasket beginning in FY 2014 to reflect FY 2010 cost data
  •  Add five cost categories
  • Revise several price proxies
The agency also proposes to add an item to the Minimum Data Set (MDS) to record the number of distinct calendar days of therapy provided by all the rehabilitation disciplines to a beneficiary over the seven-day look-back period, among other changes. Comments on the rule are due no later than 5 p.m. (EST) July 1, 2013.
The proposed rule for IRFs increases Medicare payments by 2% ($150 million) in FY 2014. CMS revises the list of diagnosis codes that are used to determine presumptive compliance under the 60% rule (listed in Appendix C of the proposed rule)—the regulation that distinguishes IRFs from acute care hospitals. The 60% compliance rule requires that 60% of an IRF’s patients meet one of 13 qualifying medical conditions. CMS proposes to remove all non-specific codes from Appendix C and replace these codes with more specific codes, when possible.
The agency states the following:
If the IRF does not have enough information about the patient’s condition to code the more specific codes on the IRF-PAI, we would expect the IRF to seek out additional information from the patient’s acute care hospital medical record to determine the appropriate, more specific code to use.
Comments on the rule are due no later than 5 p.m. (EST) July 1, 2013.
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