This is what we have on the “stove” cooking for you right now:

1. Our website section on the federal health care reform bill will continue to grow and evolve as the various provisions are sorted out by the implementing agencies. If you haven’t yet taken a look at the current list of documents on our website, please do so here:  

2. Our Board and Committee Chairs will get an overview from Michael Scandrett from LPaC Alliance at our April 29 Board of Directors meeting. That will give us the opportunity to prioritize the resource needs of our members in developing our overall multi-year action plan for resources, seminars, and committee work. 

3. MDS 3.0: For our nursing facility members, the biggest challenge coming up soon is the implementation of the 3.0 version of the Minimum Data Set (MDS 3.0). We have already started our educational programming to get you ready—we have planned a “tiered” approach, starting with three webinars to build a foundation, then going into detail with June and July in-person events. Right now we are focusing on MDS 3.0 implementation because we know, without any further action from Congress, the Centers for Medicare and Medicaid Services (CMS) is moving ahead with implementation on October 1 of this year. 

MDS 3.0 implementation, changes to concurrent therapy and MDS look-back period are all being implemented October 1, 2010 since they were contained in the same rule drafted by the Centers for Medicare and Medicaid Services (more on what those mean below). The health care reform legislation delays the ACTUAL implementation of the new RUGs IV classification system under Medicare Part A until October 1, 2011. Having said that, you should know that RUG-IV was originally scheduled to be implemented alongside the MDS 3.0 this October, but an amendment to the health care bill will not allow RUG-IV to be implemented before October 1, 2011. Our national Association was unable to eliminate the delay in RUGs IV implementation during the reconciliation process because of strict procedural rules; they continue to work on a legislative fix that will implement all aspects of the final rule, including RUGs IV yet this October. 

Your Association is currently moving ahead, however, with training and resource materials only on what is current law—certainly if there are changes in Washington during the next months to amend current law and allow for RUGs IV implementation this year, we will amend our educational plans accordingly. As a “heads up”, though, Resource Utilization Group (RUG) IV will have 20 new categories, delete seven categories for a net increase of 13 and a total of 66 categories, with patients moving towards new categories for medically complex patients. The transition from RUG-III to RUG IV is supposed to be budget neutral in the aggregate. 

Folks have asked questions about what the concurrent therapy and look back mean, especially since those changes are coming up right around the corner. Here is the simplest explanation I could find: 

Concurrent Therapy: Physical and Occupational therapists, as well as Speech/Language Pathologists, provide and bill for services under one of three clinically accepted modalities: 1) one on one individual therapy; 2) “group” therapy for patients with similar goals and interventions; or 3) “concurrent” therapy, to multiple patients at the same time under direct therapist supervision. Under the new provisions, CMS changes the rules for concurrent therapy by apportioning payment among patients treated concurrently and by counting as “treatment” minutes only the apportioned therapist time rather than the actual number of therapy minutes performed by patients. By apportioning minutes and not counting the actual number of therapy minutes experienced by patients in concurrent sessions, patients are assigned to lower RUG (Resource Utilization Group) categories with lower payment levels. 

Look Back: Part of the MDS process allows clinical staff to “look back” at certain conditions and services/treatments provided to the patient over a designated period of time. For example, on admission, MDS permits the nurse to look back at the hospital chart to note treatments that were provided, such as intravenous therapy, which will need to be followed up on in the nursing facility. Under the new rule, the look back information can only be used for clinical purposes and not for billing purposes.