Quiz: Guiding Principles of LTC – RMTP 2025

All SNF Rules and Regulations can be divided into 2 main categories. Most rules will fall into 1 category or the other. These 2 main categories are:

If Medicare rules state that an assistant does NOT need onsite supervision when providing therapy but the State Practice Act for that Discipline where you live requires a therapist to be onsite when an assistant is treating, which rule do you follow when treating a Medicare resident?

The name of the CMS Manual that contains all rules and regulations pertaining to the care of a resident in a SNF is called:

What rule / regulation is the “master” of all rules governing long term care?

Survey  F Tag 675: Quality of Life states:

“Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psycho-social well-being, in accordance with the comprehensive assessment and plan of care.”

This statement pertains to all residents (short-term rehab, long-term care, dementia, end-of-life….) and implies that therapists have a responsibility ensure each resident attains and maintains his/her highest level of function. This may include regular screening, evaluation, treatment, setting up a maintenance plan of care, and making recommendations to nursing for resident care. 

OBRA 87 created the MDS (Minimum Data Set) as a means to help SNF’s determine how to evaluate residents and then set up an appropriate plan of care to keep residents at their highest level of function. The MDS had nothing to do with reimbursement when first created.

Which of the following are types of Medicare coverage?

Medicare Part B pays 100% of all therapy costs in the SNF.

Some examples of Medicare Part C payers in the SNF are: (Check all that apply)

The Medicare Benefit Policy Manuals contain all Medicare regulations. In what Chapter can the rules for Part A in the SNF be found?

The Medicare Benefit Policy Manuals contain all Medicare regulations. In what Chapter can the rules for Part B in the SNF be found?

The following statements are true:

• Medicare only pays for “skilled care,” regardless of Medicare type – Medicare Part A and Medicare Part B
• All payment is based on providing SKILLED SERVICES…or services that require the SKILL of the NURSE or THERAPIST and cannot be provided by non-skilled professionals

State Survey Teams use the rules in the CMS State Operations Manual to ensure SNFs are following the regulations for the care of the resident.

These rules, which are the same for every state, are separated into categories and spell out to Surveyors how to conduct a review. (ie: what to look for).

SNFs have access to this information which can help prepare for survey. What is the name of this document set State Surveyors use to review each area of care? 

Therapy staff need to be aware of the questions on the Resident Interviews, Resident Observation, Record Reviews, and Critical Element Pathways for residents on their caseload. Therapy staff should be able to answer State Surveyor questions about residents they are working with, including identifying residents with adaptive equipment, pressure ulcers, contractures, Enhanced Barrier Precautions, etc.

The CMS State Operations Manual sets the framework for all the rules regarding resident care and practice that SNFs are required to follow, including the rules pertaining to therapy involvement in resident function. In order to comply with these Federal Regulations, it is likely that therapy staff will be involved in resident activity that is not reimbursable. (ie: screening).

However, there are therapy practices that can be established to meet the Federal requirements that are reimbursable. (ie: Evaluating for a change in range of motion in a resident with limitations).

Part of the role of the Rehab Manager/Director to be aware of the regulations and set up best practices to meet them, whether reimbursable or not.