SNF Documentation

Skilled Nursing Facility (SNF)

clients must be seen by an MD within 30 days of admission for comprehensive initial evaluation, then seen at least every 30 days for the first 90 days and then at least every 60 days thereafter

facility dependent: most clients are seen within 24-72 hours by an MD upon admit; then 1-2x/week for the first month; frequency afterwards will vary depending on client’;s medical status/stability

24/7 licensed nursing care

must require skilled nursing or rehabilitation services

basis of payment: payment driven payment model (PDPM) effective October 1, 2019

length of stay: up to 100 days providing there is a continuing skilled medical need (Medicare Part A)

Role of OT

self care re-retraining

adaptive equipment assessment and training

compensatory techniques

environmental access and modifications

behavioral/mental health issues

IADL re-training

community re-integration

program development

Patient Driven Payment Model (PDPM)

therapy minutes no longer used to determine payment

based on patient characteristics and needs

only 2 scheduled MDS assessments in a 100 day stay (at admission and discharge)

MDS is completed at admission and captures key beneficiary characteristics including patient’s diagnosis and function

characteristics set the base payment per day to to cover 6 components

payment will be consistent

once category is determined, based rate changes predictably over the LOS

6 Components that Influence the Beneficiary Daily Rate

SLP

OT

PT

nursing

non-therapy ancillary (prescription drugs and supplies)

non case mix (room and board, capital costs)

OT Daily Rate

PDPM clinical category

OT clinical category

OT and PT functional score

group and OT case mix index (CMI)

OT and PT Functional Score

determine by item in section GG

items are scored from 1 (dependent) to 6 (independent)

the scores of 10 items are converted into points which make up functional score

Considerations for Group, Concurrent and Individual Therapy in SNF

individual therapy must be a minimum of 75% of total therapy minutes

group and concurrent therapy is limited to 25% of minutes combined

a client performing tasks independently is typically not skilled therapy

interventions should always be skilled and medically necessary

documentation should always demonstrate the skill and distinct value of OT

Concurrent Therapy

one therapist with two patients doing different activities

Group Therapy

one therapist with 2-6 patients doing the same or similar activities

OT SNF Evaluation Checklist

occupational profile

ADL/iADLs

functional cognition

fall prevention/fear of falling

psychosocial participation/behavioral skills

vision

context and environment

driving and community mobility

SNF Quality Measures

metrics used by the centers of medicare and medicaid services (CMS) to evaluate the quality of care provided in SNF

MDS based measures (pressure ulcers, falls, mobility decline)

clients based measures (readmissions, mortality)

quality reporting program measures (functional outcomes, pressure injuries)

OT Practice Implications due to PDPM Changes

CMS will still monitor amount of therapy as week as patient access to therapy

CMS requires SNFs to provide the erases that each individual patient needs and facilities must keep a record of therapy provided

PDPM does not specify which practitioners must provide what type of care. OT may be best suited to meet a patient’s need in the areas of cognition and swallowing → address functional cognition and swallowing when appropriate

regardless of clinical group, patients of all levels are eligible for some level of care. plan of care must be driven by patient needs

SNF Coverage

a benefits period starts the day a person is admitted into a SNF under Part A of Medicare

each admission is allotted 100 days of coverage

breaks in SNF care