Exploration of Updated Payment Models for Therapy under PPS Continues

Acumen, the CMS contractor charged with analyzing potential therapy payment models under the Prospective Payment System (PPS), has established a Technical Expert Panel (TEP) to assist in its task of identifying, evaluating, and proposing potential alternatives to the current Skilled Nursing Facility (SNF PPS).

The panel is examining the feasibility of making improvements in the payment system to reduce the incentivizing of therapy services based on minutes of therapy provided, while maintaining quality outcomes for residents.  The TEP held a meeting to examine this multi-faceted concern and summarized their discussions and recommendations in their recently published report entitled: Skilled Nursing Facility Therapy Payment Models Technical Expert Panel Summary Draft.

The panel took a comprehensive look at the challenges of amending the current therapy minutes driven system to include alternatives such as "per day", "per stay", and "per benefit period" payment options.  Functional scoring options related to Activities of Daily Living (ADL) summary score versus functional outcome measures were examined as well. Additionally, the panel considered quality monitoring systems, the ability to accurately predict care based on resident characteristics, and data challenges related to the ICD-9 and ICD-10 conversion.

Contact:  Michelle Synakowski, msynakowski@leadingageny.org, 518-867-8850