What SNF Therapy & MDS Professionals Need to Know

May 11, 2023 is the last day of the Public Health Emergency (PHE) and the final day for the remaining associated waivers and exceptions.

CMS has posted multiple resources to help in the transition. The following resources are a must for SNF therapy professionals to read:

Important Part A Coverage Information

Important information from the above documents includes the following:

  • The Qualifying Hospital Stay (QHS) waiver can be used on May 11th, up to the end of the day. Beginning May 12th, the waiver is no longer in effect, and a 3 midnight qualifying hospital stay will be required to allow initiation of the Part A benefit.
  • Residents that continue coverage under Part A on May 12th that used the QHS waiver to initiate Part A coverage (without a qualifying hospital stay) prior to May 11th, will be able to continue Part A coverage after May 11th, assuming all criteria for skilled care is met.
  • If there is a break in Part A coverage on or after May 12th for residents that used the waiver on or before May 11th because a qualifying hospital stay was not present, these residents will require a new qualifying hospital stay to resume Part A coverage.
    • This excludes residents that go to the hospital and return in the interrupted stay window (less than 3 midnights away from the SNF). Part A will pick up where left off.
    • This includes residents that go to the hospital and return after the interrupted stay window. [Think of it as residents requiring a new Part A 5 Day PPS MDS are required to have a QHS to back it up.]
      • Example: a resident on Part A under the waiver goes to the hospital, and is out of your facility for 3 midnights, thus not meeting the interrupted stay requirements. However, resident was under observation in the ER for night 1, then admitted for the 2 final days. Upon return to your facility, this resident would not be able to resume Part A coverage as there was no interrupted stay, AND no new 3 day QHS (because of 1 observation day).
    • This includes residents who used the waiver on or before May 11th, ended their Part A benefit and have days left in their benefit period, and wish to resume Part A coverage in the 30 day window following their last covered day. These residents are not eligible to resume Part A coverage because of no QHS originally. These residents require a new QHS to access the remainder of their Part A days. [A new 5 Day PPS MDS would be needed.]
      • Example: a resident who started Part A without a qualifying hospital stay under the waiver in April, and was then cut from Part A either before or after May 11th, can not restart Part A coverage in the 30 day window from the last Part A day. A new 3 day qualifying hospital stay would be required to start Part A, since the original Medicare Start Date was under the waiver.
    • Tip: If the Medicare Start Date on the MDS is May 12th or later, a QHS is needed. If a 5 Day PPS MDS is needed on May 12th or later, a QHS is needed.
  • The CR modifier and DR condition codes used on claims during the PHE to indicate waiver use should be discontinued for claims with dates of service on or after May 12th.
    • The exception to this is for claims with admission dates before May 12th (benefit period and qualifying stay waivers) who are currently in a Part A stay due to waiver use prior to May 11th.

If you are interested in the earlier CMS releases of post-PHE direction, these resources will help:

Telehealth

Telehealth flexibilities have been extended by Congress through 12/31/2024.

More information on the timeline of telehealth, and how therapy professionals have been included in the most recent rulemaking, can be found HERE, including the most current list of accepted CPT codes.

We can expect to receive additional CMS guidance regarding specific requirements for individual settings (SNF vs Private Practice) after the PHE ends. It is possible that rulings for institutional providers and private practice providers will differ.

Regardless of CMS’s rulings, therapy providers need to check with their discipline-specific State Practice Act for telehealth rules. States that temporarily allowed telehealth during the PHE may revert back to prior regulations once the PHE ends. Professionals are responsible for inquiring at the state level for specifics.

PTA / OTA Supervision

Medicare’s definition of supervision of the PTA/OTA in the SNF setting for Part A and Part B currently is and pre-PHE has always been “general,” which does not mandate onsite or in suite supervision.

Private practice settings, however, require “direct” supervision, which has been flexed to allow “virtual supervision” during the PHE. This is set to expire 12/31/2023.

The SNF setting requirement will not change with the end of the PHE.

Any new communications from CMS will be added to this page as we transition away from the PHE.

Any questions, send them to our Just Ask Q&A Page HERE

In your corner,

Dolores

Dolores Montero, PT, DPT, RAC-CT, RAC-CTA

Montero Therapy & MDS Resource Team

MonteroTherapyServices.com