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CMS proposes adding respiratory therapy to specialized rehabilitative services in LTC

In July, CMS proposed a new rule that would that would revise the requirements of participation for LTC communities. The Medicare and Medicaid Programs: Reform of Requirements for Long-Term-Care Facilities rule represents a comprehensive revision, which proposes the addition of new requirements to improve patient safety and the quality of health care furnished through federal programs. Part of the changes covered by the proposed rule is the addition of respiratory services to those services identified as specialized rehabilitative services. The comment period for the rule closed on September 14, 2015.

The following is the language included in the section that addresses respiratory therapy:

Current regulations at §483.45 set forth the services that a facility must provide if a resident needs specialized rehabilitative services including, but not limited to, physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness. Following our proposed reorganization of part 483 subpart B, we propose to relocate these existing provisions to proposed §483.65 with minor revisions.

Consistent with specialized rehabilitative services, the need for respiratory therapy and respiratory illnesses are very common among older adults; however, the current regulations do not discuss respiratory therapy. According to data collected by the Centers for Disease Control and Prevention (CDC), 6.7 percent of nursing home residents have some form of disease of the respiratory system at the time of their admission into a nursing home (The National Nursing Home Survey. 2004 overview: National Center for health Statistics. Accessed January 10, 2013).

In addition to the occurrence of respiratory illnesses at admission, outbreaks of respiratory tract infections are also common in LTC facilities among older adults. In LTC facilities, rates of pneumonia as high as 42 percent and case-fatality rates exceeding 70 percent have been reported in outbreaks due to the influenza virus (Loeb M, McGeer A, McArthur, Peeling R, Petric M, Simor A. Surveillance for outbreaks of respiratory tract infections in nursing homes (cover story). CMAJ: Canadian Medical Association Journal [serial online]. April 18, 2000; 162(8):1133-1137. Available from: Health Policy Reference Center, Ipswich, MA. Accessed January 23, 2013).

Given these statistics and our prior knowledge about the need for respiratory-related treatment and therapy in facilities, we propose at re-designated §483.65(a) to specifically add respiratory therapy to the list of specialized rehabilitative services. Adding this service to the regulations would reflect the more current needs of facility residents. The addition of this service would also explicitly require facilities to provide or obtain these services when necessary and meet the needs of residents facing respiratory issues. However, this would not change coverage policy regarding respiratory therapy. At §483.65(a)(2), we propose to clarify that when it is necessary for facilities to obtain these services from an outside source, the provider should be a certified Medicare and/or Medicaid provider.

Additional information
A respiratory therapy program can be a valuable tool to help your community more effectively treat respiratory illnesses like pneumonia – as well as cardiopulmonary conditions that often lead to avoidable hospital readmissions, including congestive heart failure, COPD, and cardiac dysrhythmia. If you would like to learn more about respiratory therapy, please contact Alliance Rehab Corporate Director of Outpatient Services Luis Montes at (630) 413-5865 or This email address is being protected from spambots. You need JavaScript enabled to view it..

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