Harmony Healthcare Blog

Rehabilitation Services Impact on Medicaid Case Mix

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Jun 21, 2010

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Edited by Kris Mastrangelo

Impact Rehabilitation Services Impact Medicaid Case Mix:  Rehabilitation Therapists are integral members of the interdisciplinary team as is their participation in the process of resident assessment.  The routine therapy screen assists in identifying areas of decline or the potential for improvement, before loss becomes permanent or opportunities for improvement are missed. 

Many facilities complete annual screens.  The proactive timing of screens may positively impact resident function; Medicaid reimbursement as well as the Facility Quality Indicators in risk indicators.

Optimal scheduling of routine screens involves completing the screen in conjunction with the OBRA assessment.  It is beneficial to complete the screening process 2 weeks before the scheduled Assessment Reference Date in order to coordinate services as indicated.  The facility should have a system in place to review all residents quarterly, in addition to the annual therapy screen.  In a small facility, quarterly screens may not be financially feasible.  Even though a formal screen in writing may not be complete, therapy should review all residents scheduled for quarterly assessments.  The program manager can review the current MDS list with each unit manager and a CNA -representative, to discuss areas that may trigger a formal screen.  Facility use of a monthly MDS Schedule to alert staff of MDS assessments due and care plan meetings is useful.  Harmony recommends dividing the list into weekly lists as a reminder to staff of upcoming assessments. All Medicare and Significant changes assessments can also be scheduled.  This would eliminate the need for interim notifications that are currently used.  These weekly schedules can be used by therapy to prompt a clinical discussion with unit managers.  Schedules can be kept in the therapy room with notes regarding follow-up and that the resident has been discussed.

This valued intervention is supported in regulations (F406:  §483.45 Specialized Rehabilitative Services).  The intent of this regulation is to assure that residents receive necessary specialized rehabilitative services as determined by the comprehensive assessment and care plan, to prevent avoidable physical and mental deterioration and to assist them in obtaining or maintaining their highest practicable level of functional and psycho-social well-being. 

There is great value in reviewing with nursing any potential indicators for therapy referrals and educating nursing the role of therapy for the long-term care resident.  The CNA is also a very valuable member of the team as they spend the majority of time with the resident and may be the first to observe changes in function.

It is important to note that an assessment may be done early but never beyond the 92 days allocated.  There is the option of also completing an additional assessment as the RAI Users Manual indicates that Quarterly assessments are to be completed minimally 3 times per year following a comprehensive assessment.

In order to obtain maximum impact for these delivered therapy services, an Assessment Reference Date needs to be planned and set to capture:



Very High Intensity Multidisciplinary Rehabilitation: 500 minutes or more of therapy per week (P.1.b.B) AND 5 days or more per week of one type of therapy (P.1.b.A.) AND 2 or more different types of therapies (P.1.b.)

High Intensity Rehabilitation: 325 minutes or more of therapy per week (P.1.b.B.) AND 5 days or more per week of one type of therapy (P.1.b.A.)



Medium Intensity Rehabilitation:

150 minutes TOTAL minutes or more of therapy per week (P.1.b.B.) AND 5 days TOTAL days of therapy or more per week of therapy (P.1.b.A).



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Tags: Case Mix, ARD, Rehab Case Management

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