1. Start Date: October 1, 2019

2. Applies only to traditional Medicare Part A Skilled Nursing Patients

3. PDPM is a site-neutral reimbursement structure for post-acute care.

4. May impact SNF episodic spending

5. May create opportunities for SNF to increase their clinical scope to accept higher acuity patients

6. Increase of information needed from the hospitals transfer documentation to justify all active conditions:

  • History
  • Physical
  • Medication List
  • Labs
  • Therapy progress notes
  • Chest X-ray
  • Immunizations

Additional requested information under PDPM

  • ICD.10 codes with specificity
  • All active diagnoses
  • Post-Operative Reports
  • Any physician consults

7. PDPM should NOT affect the timeliness in which patients are accepted by Skilled Nursing Facilities

8. PDPM should not drastically reduce the amount of therapies provided or weekend availability

9. This is the largest change to SNF reimbursement in 20 years

10. There is opportunity to improve processes and care collaboration between hospitals and SNFs for optimal success under PDPM

Every year, the National Rehabilitation Awareness Foundation designates a week in September to educate people about the benefits and impact of rehabilitation.

Physical Therapy ◆ Occupational Therapy ◆ Speech Therapy

The goal of rehabilitation is to help an individual heal and achieve their highest level of independence possible. Physical Therapists (PT), Occupational Therapists (OT), and Speech-Language Pathologists (SLP) all work together to help individuals overcome obstacles and accomplish normal tasks of daily living. These therapists work on an individual level, which is beneficial for a range of conditions/diseases, ages and abilities.

Physical Therapy are experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect peoples’ abilities to move the way they want and function as well as they want in their daily lives. Treatment is aimed to reduce pain and improve range of motion, flexibility, strength, endurance, and mobility.

Occupational Therapy uses goal-directed activity in the evaluation and treatment of persons whose ability to function is impaired by normal aging, illness, injury or developmental disability. Treatment goals in occupational therapy include the promotion of functional independence and prevention of disability.

Speech-Language Pathology (Speech Therapy) is the study, diagnosis, and treatment of defects and disorders of the voice and of spoken and written communication. Speech therapy also evaluates and treats neurological and physical disorders and conditions caused by an injury or illness.

When Can Therapy Help?

  • Joint Replacements
  • Post-Orthopedic Surgeries
  • Balance & Gait Training
  • Arthritis
  • Fractures
  • C.V.A (Stroke)
  • Lymphedema
  • Cardiac Conditions
  • Pain Management
  • Back & Neck Pain
  • Parkinson’s
  • Neurological Conditions
  • Swallowing Disorders
  • Language & Cognitive Function
  • Generalized Weakness, or Decrease in Strength

Article by Skilled Nursing News

The federal government on Tuesday finalized a predicted funding increase for nursing homes, while also formalizing changes to several key quality programs — with an eye toward clarifying some parts of the new Medicare payment model for skilled nursing facilities.

Under the terms of the 2020 final rule for Medicare skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) will increase payments to nursing homes by $851 million in the coming fiscal year, which begins October 1 of this year.

That figure represents a slight drop-off from the increase of $887 million projected in the proposed version of the rule, which CMS released back in April; the $851 million comes from a 2.8% increase to the Medicare market basket rate in the final rule, as opposed to a 3% rise in the proposal.

The Tuesday announcement also includes several clarifications related to the Patient-Driven Payment Model, also set to take effect October 1. CMS formally changed the definition of “group therapy” to any modality with two to six residents performing the same or similar activities. That change brings group therapy in SNFs more in line with other care settings, such as inpatient rehabilitation facilities, which use the same definition; CMS currently defines group therapy as activities with exactly four residents.

“As PDPM implementation takes place, CMS believes aligning the group therapy definition serves to improve the agency’s consistency in payment policies across PAC settings,” the agency wrote in a fact sheet about the changes.

Click here to continue reading this article.

The Centers for Medicare and Medicaid Services issued the FY 2020 Skilled Nursing Facility Prospective Payment System Final Rule which will take effect on October 1, 2019.  This rule finalizes payment policies for Medicare Part A in SNFs and updates the SNF Quality Reporting and Value-Based Purchasing Programs. Below are the highlights:

  • SNF market basket percentage is 2.4% or $851 million for FY 2020 (decreased from the proposed update of 2.5%).
  • The unadjusted urban and rural federal per diem rates will decrease slightly compared to the proposed rule rates.
  • Come October 1, 2019, group therapy will be defined as, “a qualified rehabilitation therapist or therapy assistant treating two to six patients at the same time who are preforming the same or similar activities.”
  • The sub-regulatory process for updating the ICD-10 codes used to classify patients under PDPM has been finalized for FY 2020.
  • Two new quality measures for the SNF QRP related to transfer of health information have been adopted.
  • Baseline nursing home residents will be excluded from the Discharge to Community Measure.
  • The quality measure for Drug Regimen Review Conducted with Follow-Up for Identified Issues will be publicly displayed.
  • The “5-Day Assessment” will be called “Initial Medicare Assessment.”
  • Clarification on the optional Interim Payment Assessment was provided stating, “…the SNF’s underlying responsibility to remain fully aware of (and respond appropriately to) any changes in its resident’s condition is in no way discretionary. Moreover, the discussion of the IPA in the FY 2019 SNF PPS final rule (83 FR 39233) clearly envisions a role for this assessment that is not strictly limited to payment alone: “We continue to believe that it is necessary for SNFs to continually monitor the clinical status of each and every patient in the facility regularly regardless of payment or assessment requirements and we believe that there should be a mechanism in place that would allow facilities to do this.” At the same time, in making the IPA optional, we recognized “. . . that providers may be best situated, as in the case of the Significant Change in Status Assessment, to determine when a change has occurred that should be reported through the IPA.”


For more information see  the CMS Press Release and Fact Sheet.

HTS is not only your partner in therapy – Power through PDPM with HTS’ strategies for success. HTS is able to provide comprehensive tools, policies, clinical pathways and education at all levels to ensure success under PDPM. Contact us today for more information on the HTS Partner Plus Program.

NASL Newsletter Feature: US Senator Mike Braun Visits HTS Therapy Office
On April 24, 2019, U.S. Senator, Mike Braun visited Healthcare Therapy Services (HTS) and one of HTS’ partner facilities in Indiana. NASL members were able to talk with the Senator about the hospital observation stays issue that was NASL’s top issue during the Winter Conference in February. The Senator spent about an hour visiting with staff, as well as interacting with residents.

Thank you NASL for featuring us in your latest newsletter!

Pictured: Senator Mike Braun; his wife, Maureen; Cassie Murray, HTS COO; and Keith Yoder, CEO with Hickory Creek Healthcare Corporation

Pictured: Healthcare Therapy Services representative Shaleen Bhatnagar, Regional Director; Stephen White, Rehab Manager; Cassie Murray, HTS COO; and Steve Chatham, President

by Stacy Baker, OTR/L, CHC, RAC-CT, Proactive Medical Review

The Quality Improvement Organization (QIO) Program originated with the Peer Review Improvement Act of 1982 and is authorized by Title XI Part B and Title XVIII the Act. The goal of the QIO program is to improve the quality of care for Medicare beneficiaries, including beneficiary complaints, skilled service termination appeals, and Immediate Advocacy to protect the Medicare Trust Fund. The QIO program is to achieve this goal through performance of various case review directives promulgated by CMS in the QIO Contract.

As of June 8th, important updates apply to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QI) in Indiana and Kentucky. Providers should review documents and publications noted below with references to KEPRO. The following actions should take place:


  • Remove KEPRO (effective June 8, 2019) and replace with Livanta information

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

According to the CDC, more than 25% of all American adults sit more than 8 hours a day. In fact, adults spend more time sitting and being couch potatoes than sleeping. That number increases even more for older adults; statistics show that 75% of older adults are sedentary.

Sitting too much can be very harmful to your health. Numerous research studies show that the more you move and stop sitting, the longer you will live. Sitting too much increases your risk of obesity, diabetes, cancer and early death.

What Happens to Your Body When You Sit?

  • Electrical Activity in Leg Muscles Shuts Off
  • Calorie Burning Drops to 1 per Minute
  • Enzymes that Help Break Down Fat Drop by 90%
  • Good Cholesterol Drops by 20%
  • High Amounts of Stress are Placed on Your Lower Back and Neck


The World Health Organization suggests adults aged 65 years and above should do at least 150 minutes of moderate-intensity physical activity throughout the week. Regular physical activity of moderate intensity has significant benefits for health. At all ages, some physical activity is better than doing none. By becoming more active throughout the day in relatively simple ways, people can quite easily achieve the recommended activity levels. Walking is the easiest form of exercise for older adults and swimming is a good option as well.


Therapy Can Help Aging Adults Stay Active & Independent

Exercise is extremely important in managing many common symptoms of aging. Physical therapists evaluate your needs and teach you how to exercise appropriately for joint mobility, muscle strength and fitness. Occupational therapists help older adults to safely do the things they want to do, stay active and live well despite limitations. Therapy can help with pain associated with sitting too much, address postural issues, and create strategies to get you moving more and sitting less.

References: World Health Organization, CDC, AARP.org

Byron Health Center Fights to End Alzheimer’s
Byron is a class act group who laughs in the face of mediocrity and never stops challenging the status quo. Be sure to follow them on Facebook and check out their gorgeous website as they recreate senior living at their new location coming soon! We are proud to be your partner in therapy and changing lives!

Follow along with our Facebook page to see how we’re helping communities just like yours!

Ripley Crossing Receives National Accreditation For Excellence
Congratulations, Ripley Crossing and thank you for your commitment to quality! We are proud to be your partner in therapy.

Follow along with our Facebook page to see how we’re helping communities just like yours!

We LOVE our friends and partners at Golden Years Homestead!

Set Your Community Apart with Rehab Services
HTS Outpatient Rehabilitation provides your senior living community with convenient, on-site therapy and wellness services to support independence, safety and quality of life for your residents. We provide the very best in programming, equipment and care collaboration to restore your residents to their maximum potential.

Follow along with our Facebook page to see how we’re helping communities just like yours!