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The Critical Role of Rehabilitation Therapy
in the SNF PPS, Post-Acute Reform,
and Long Term Care

Sunday, October 5   •  8:00 am – 5:00 pm

This is a separate ticketed event—register through AHCA or NASL.

Held in partnership with


The American Health Care Association (AHCA) and the National Association for the Support of Long Term Care (NASL) present an exciting, first-time, full-day joint event for therapy clinicians, managers, educators, rehabilitation nursing coordinators, billing/reimbursement specialists and all those involved in the provision of nursing facility rehabilitation therapy. Experts will provide the latest information on cutting edge rehabilitation therapy outcomes research, policy, quality, Part A and Part B payment, and clinical issues. We will also explore key government initiatives to redesign therapy payment as well as AHCA and NASL rehabilitation initiatives. We will bring all the issue streams together in a comprehensive examination of nursing facility rehabilitation therapy.

8:00 am Welcome: Mark Parkinson, President & CEO, AHCA
Cynthia Morton, Executive Director, NASL
8:20 –8:45 am Introduction: Goals for the Day
Speakers: Mary Van De Kamp, Sr. Vice President, Quality and Care Management, Kindred Healthcare; Mary Ousley, President, Ousley & Associates, Past Chair of AHCA

8:45 –9:30 am Session 1. SNF PPS and Rehabilitation Therapy -- Why is There a Controversy?
Speakers: Elise Smith, Senior Fellow, Health Policy and Post-Acute Care, AHCA; Dr. David Gifford, Senior Vice President, Quality and Regulatory Affairs, AHCA

The current Medicare Part A SNF PPS is a fee-for-service payment policy that has been in existence since FY 1998. It appears that it will be overtaken by evolving payment and care systems including comprehensive post-acute system(s), site-neutral approaches, bundled payment, ACOs, mega-managed care, Medicare & Medicaid dual payment/care systems and more. But, for now, the SNF PPS is in effect and will be for some years to come. It will function also with respect to ACO contracts and perhaps as a fundamental aspect of site-neutral payment.

CMS believes that the system incentivizes volume over outcomes, especially with respect to rehabilitation therapy and is striving to reform, in particular, the delivery and payment for therapy within the PPS itself.

This session will analyze possible system root causes of the current concerns. The presenter will review CMS' efforts to address what is sees as the vulnerabilities of the system and its decision to try to replace the "wrong" utilization incentives with patient driven clinical criteria and condition based tools. The groundwork will be laid for a discussion of the current major efforts to reform the payment of rehabilitation therapy within the SNF PPS. Change is important – and the correct change even more important – to effective and efficient care under the SNF PPS and future care/payment models.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
  • Explain the conflicting pressures associated with assuring beneficiary access to appropriate and effective SNF rehabilitation therapy under the traditional SNF PPS payment model, while controlling costs.
  • Understand the root causes of government concern regarding rehabilitation therapy.

9:30-9:45 am Break
9:45 –11:45 am Session 2. SNF PPS Part A Rehabilitation Therapy -- Addressing the Controversy & Redesigning Therapy Payment
Speakers: Dr. David Gifford, Senior Vice President, Quality and Regulatory Affairs, AHCA; Rachel Feldman , Partner, The Moran Company; Anne Deutsch, RN, PhD, CRRN Rehabilitation Institute of Chicago; Tara McMullen, PhD(c), Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services; Barbara Gage, PhD, Managing Director, Engelberg Center for Health Care Reform, Brookings Institute

The presenters will discuss the payment/care design work of key constituents including CMS, MedPAC, the Urban Institute, Acumen and Brookings, and AHCA & NASL. The specific clinical problems and issues that drive the various research routes, such as the CARE item set and uniform assessment, and other collective efforts will be explained, and the array of solutions proffered will be clarified.

Tough clinical issues such as determining what the "right" amount of therapy is for each patient will be addressed and the relevance of research and policy discussions to the critically important "on the ground" work with our facility patients will be a focus of this session.

AHCA and NASL have not sat on the sidelines of rehabilitation therapy issues but rather have conducted critical work to bring to the table. Presenters will describe specific AHCA/NASL quality and payment model research projects designed to use available data and new patient-centered measures for quality and outcomes and their current status . These include : standardized outcomes measures for reporting function and quality, and alternatives to counting therapy minutes for the Part A SNF therapy component. The speakers will consider how the emerging results of this research can assist rehabilitation therapists in their current patient-centered efforts.

The presenters will provide best estimates of the time tables involved in the ultimate development of universal comprehensive outcome measures and the development of a robust therapy component for the SNF PPS.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
  • Understand the current therapy clinical issues that are of concern to the CMS and Med PAC.
  • Understand the relevance of research and policy discussions to the critically important " on the ground" work with our facility patients.
  • See how the emerging results of this research can assist rehabilitation therapists in their current patient-centered efforts.
  • Explain the key role of the CARE assessment items in SNF and post-acute reform initiatives.
  • Describe specific AHCA/NASL quality and payment model research projects, designed to use available data and new patient-centered measures for quality and outcomes, as alternatives to counting therapy minutes for the Part A SNF therapy component.

11:45 am -12:30 pm Lunch
12:30-2:30 pm Session 3. Nursing Facility Part B Rehabilitation Therapy -- Crucial to a Quality Life but Under Fire
Speakers: Cynthia Morton, Executive Vice President, NASL; Daniel Ciolek , AHCA, Senior Director of Therapy Advocacy; Helene Fearon, Partner, Fearon & Levine Consulting

Part B therapy services have a long history of being irrationally regulated and limited. The shame of such policies is that rehabilitation therapy is crucial to the ability of the elderly to rebound from physical debilitating events and setbacks. It is central to their quality of life. Part B therapy services are key to enabling nursing facility residents to return home, or to live in the NF environment with a high quality of life.

A myriad of legislative and regulatory initiatives to control costs are still in motion, and while there is a growing hope that Congress will permanently repeal the therapy caps and replace them with common-sense patient-centered policies recommended by AHCA, NASL and other provider and beneficiary stakeholders, SNF therapy providers still need to navigate a burdensome cap exceptions process, a manual medical review (MMR) process that unfairly targets the most needy beneficiaries, most commonly receiving services in a SNF, and complex and burdensome utilization edits.

This session will provide up-to-date information related to current policies impacting Part B fee-for-service rehabilitation services, including therapy caps, medical review, appeals procedures and delays, and restorative vs. maintenance documentation requirements related to the Jimmo v. Sebelius settlement agreement. Did Jimmo usher in a new era of coverage or did it just confirm what was already available but not understood by the Medicare providers and contractors?

In the future, will Part B therapy always be delivered in a per-procedure fee-for-service payment system? Or will payment shift to per-session, per-episode, or other payment models? The presenters will discuss the critical work on alternative payment systems impacting Medicare Part B therapy service providers and patients being explored by CMS, MedPAC, The AMA CPT Editorial Panel, AHCA & NASL.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
  • Describe the current Part B therapy payment policies that apply in the SNF setting.
  • Discuss the key components of the therapy cap repeal legislation being advocated for by AHCA, NASL and other provider and advocacy organizations to Congress.
  • Apply current knowledge of how CMS and HHS are conducting appeals to facilitate more timely resolution of appeals.
  • Implement appropriate medical necessity decision-making, and provide adequate documentation to better assure coverage of skilled maintenance services under the guidelines established by the Jimmo v. Sebilius settlement agreement.
  • Describe the current work being conducted by AHCA, NASL, and other organizations on developing alternative Part B therapy payment models and the implications of transitioning from per-session, per-episode, or other payment models.

2:30-2:45 pm Break
2:45- 4:15 pm Session 4. Current Trends in Delivery System Reform
Speakers: James Michel, Director of Medicare Research & Reimbursement, AHCA; Joanne Powell, Director of Reimbursement Strategies, The Evangelical Lutheran Good Samaritan Society; Mark Besch, Vice President of Clinical Programs, Aegis Therapies

Medicare is evolving rapidly into new delivery system and payment reform models, including accountable care organizations (ACOs) and bundled payments. Additionally, payment reforms such as site neutral payment are being explored by policymakers as yet another possible improvement to the current fee-for-service system. Health care providers will need to know what new changes are coming, and to understand how to adapt and succeed in these new models of care delivery.

This session will explain which different models are being proposed, what they mean for skilled nursing providers, and how they may impact the delivery of rehabilitation therapy services. Additionally, a panel of member providers will talk about their on-the-ground experiences in redesigning care delivery within these new models, discussing lessons learned and the opportunities posed to skilled nursing facilities in this rapidly evolving environment.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
  • Understand current, national trends in payment and delivery system reform in the Medicare program.
  • Gain a fuller understanding of the array of different models being proposed and tested, and understand where SNFs fit into this changing environment.
  • Describe how rehabilitation therapists in the SNF setting are currently engaged in activities that are models for the more global interdisciplinary and inter-setting collaboration necessary to successfully implement innovative programs to improve quality.

4:15- 5:00 pm Session 5. Why We Do It -- The Person Under Our Care
Speaker: Martha Schram, President, Aegis Therapy

Current developments and work are creating a strong path to a strong future. This is the real meaning of what was heard today! As we engage on transitioning towards patient-centered quality and payment models related to rehabilitation services, it is important to remember not to lose focus on the individuals we are entrusted to care for. New quality and payment initiatives can become a benefit for the human being receiving care in our facilities if we keep the focus on the patient. We need to remember:

  • The importance of rehabilitation services to persons who have developed functional loss,
  • What the term 'quality services' mean to a patient,
  • What the emerging payment models discussed today may mean to the patient, and
  • The importance of rehabilitation provider advocacy for the provision of adequate therapy services.

The person under our care is the most important reason for doing what we do, regardless of how we are paid for providing the care.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
  • Express the positive impact of rehabilitation services in fulfilling an individual's functional and quality of life needs and desires in a changing policy environment.
  • Use the information provided today to better understand and advocate the importance of rehabilitation services behalf of individuals that would benefit from rehabilitation services.


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This activity has been submitted for certification by FSBPT and is approved for 4 CCUs. The FSBPT certification is accepted by the physical therapy regulatory boards/agencies in certain U.S. jurisdictions. The boards that currently accept FSBPT certification are: Alabama, Arkansas, Arizona, California, Delaware, District of Columbia, Georgia, Indiana, Kansas, Kentucky, Montana, Nebraska, North Carolina, Oregon, South Carolina, Tennessee, Utah, Vermont, Virginia and Wisconsin. If your state is not listed above, attendees may self-submit to their state licensing board for approval.

*CEUs approved for Administrators, Nurses, OTs, and PTs

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