What You Need to Know About New Medicare Part A Regulations

Jennifer Bogenrief & Stephanie Yamkovenko

New Medicare regulations will go in to effect on October 1. How will it affect your practice? AOTA submitted comments about issues that affect occupational therapy to the Centers for Medicare & Medicaid Services (CMS) on several proposed rules this summer (read about the proposed rules and AOTA comments). Here is what you need to know about the new final rules.

If you work in an inpatient rehab facility:

Group therapy: The proposed rule asked for comments on possible restrictions of group therapy, and AOTA commented that research on outcomes is needed before limiting group therapy. In its final rule, CMS said that it believes that group therapy can serve as an appropriate mode of therapy delivery that can be beneficial to the particular needs of inpatient rehab facility patients as an adjunct to individual therapy. CMS agreed that it would be prudent to give more consideration to setting a cap and believes that collecting and analyzing the current delivery of therapy services will help inform any future policymaking.

Defining group and concurrent therapy: CMS removed concurrent therapy from the definition of group therapy and recognized it as a distinct mode of therapy, as AOTA recommended. CMS also adopted the following definitions recommended by AOTA to apply definitions consistently across Medicare’s post-acute care settings: group therapy is treating 2 to 6 patients at the same time who are performing the same or similar activities; concurrent therapy is treating 2 patients as the same time who are performing different activities.

Collecting data on the amount and mode of therapies: In its proposed rule, CMS estimated that data collection would take 4 minutes to complete, but AOTA commented that it would more likely be 15 to 20 minutes to accurately capture the therapy data. In its final rule, CMS said it believes it has taken into account that the addition of the therapy collection item will increase the time it takes providers to complete the IRF-PAI. To help minimize the burden associated with the therapy data collection, CMS is not adopting the proposed requirement to record the average number of minutes by mode and type of therapy for weeks 3 and beyond of a patient’s IRF stay. Instead, CMS will require IRFs to report only the total number of minutes of therapy provided to a patient, by mode and type of therapy, for week 1 and week 2 of the IRF stay.

If you work in a hospital:

Observation status: CMS did not make any changes to the 2-midnight rule, but it is accepting suggestions from stakeholders. Stakeholders can email suggestions for potential additional exceptions to the 2-midnight benchmark to CMS will notify providers of any additional guidance regarding the 2-midnight exceptions through subregulatory means, such as posting on the CMS website or manual instructions.

If you work in a skilled nursing facility:

End of Therapy OMRA: CMS heard that some providers had concerns about the limitations on the use of the COT OMRA, such as when reclassifying a resident into a therapy resource utilization group (RUG). AOTA asked CMS for more clarity about the way the End of Therapy OMRA works after 3 missed days when therapy is still ongoing. In its final rule, CMS agreed that its example regarding the End of Therapy OMRA was incorrect and provided a new example to clarify the scope of the revision.

CMS finalized its proposal to permit providers, in certain circumstances, to complete a COT OMRA for a resident who is not currently classified into a RUG-IV therapy group or receiving a level of therapy sufficient for classification into a RUG-IV therapy group.

Read the final rules and AOTA’s comment letters on the proposed rules

Find links to the final rules and CMS fact sheets here. Read about AOTA’s comments on the proposed rules here. AOTA is currently conducting a more thorough analysis of the final rules, which will be available for AOTA members prior to October 1.

Jennifer Bogenrief is AOTA's manager of regulatory policy. Stephanie Yamkovenko is AOTA's web editor.