HCFA makes two decisions to benefit rehab therapy

Manipulation therapy, students get nod

Rehabilitation therapy providers were thrown two bones near the end of 1999 as the Health Care Financing Administration (HCFA) clarified that physical therapists could perform manipulation therapy services under Medicare and that skilled nursing facilities could count therapy provided by therapy students.

In a Nov. 4, 1999, letter signed by Lena Robins of HCFA’s Office of General Counsel, the agency said that certain Medicare organizations can use physical therapists to provide manual manipulation of the spine, when permitted by state law. The letter, addressed to attorney Jeffrey G. Schneider of Hogan & Hartson in New York City specifically referred to beneficiaries of the new Medicare category called Medicare+Choice.

"This service may be offered to an enrollee as an alternative to receiving the physicians’ service under that section," Robins wrote.

The second win

Physical therapy, occupational therapy, and speech therapy industry leaders also called it a victory when HCFA decided in November 1999 to allow skilled nursing facilities to count minutes of therapy provided by therapy students on the Minimum Data Set (MDS) resident assessment instrument.

HCFA retracted its earlier statement that minutes of therapy provided by a student could not be recorded on the MDS because it’s an educational activity that should be treated as a pass-through expense.

The reason for the change is that HCFA now recognizes that skilled nursing facilities (SNFs) are not approved medical education programs. The correction reads, in part, "Approved programs, such as a residency program operated by the institution in which it takes place, are actively engaged in the training process and incur costs in that regard.

"By contrast, SNFs provide only the setting in which the training for these students takes place, not the management of the program itself. Because Sec. 413.85 does not apply, our statement as to the counting of student therapy minutes is also inapplicable."

HCFA advises providers to record the student therapy minutes received by beneficiaries, in accordance with the past practice established under the instructions in the Long Term Care Resident Assess ment Instrument User’s Manual and other HCFA guidelines.

The change was effective on Sept. 28, 1999.