Clarifies circumstances when SNFs  must report breaks of three or more days of therapy. When an End of Therapy (EOT) Other Medicare Required Assessment (OMRA) has been completed and therapy subsequently resumes at the same RUG level, an End of therapy with Resumption (EOT-R) OMRA rather than a Start of Therapy (SOT) OMRA, may be completed in cases where the resumption of therapy date is no more than 5 consecutive calendar days after the last day of therapy provided.

The EOT OMRA must be completed within 1-3 consecutive calendar days following the last day of therapy.  Even if the resident was not discharged from therapy services and missed 3 or more consecutive days of therapy, an EOT OMRA still would have to be completed to classify the resident into a non-therapy  RUG  group for those days of missed therapy.

Eliminates the  distinction between facilities regularly furnishing therapy services on a 5 or 7 day basis for purposes of setting the date for the EOT OMRA.

Streamlines procedures for documenting situations involving a brief interruption in therapy, where therapy resumes without any change in the patient’s Resources Utilization Groups Version 4 (RUG-IV) classification level.

Introduces a new Change of Therapy (COT) OMRA to capture those changes in a patient’s therapy status that would be sufficient to affect the patient’s RUG-IV classification and payment, even though they may not increase to the level of a significant change in clinical  status.

Provides for the allocation of a therapist’s time for group therapy (defined in the rule as a single therapist leading four patients in a common activity) to ensure that Medicare payments better reflect resource utilization and cost for these services, and specifically that the therapist’s time is being appropriately counted and reimbursed.

Discusses the impact of certain provisions of the Affordable Care Act, and announces that proposed provisions regarding ownership disclosure requirements set forth in the Affordable Care Act will be finalized at a later date.

Eliminates the difference between regular ARD window days and grace days and encourages the use of grace days if their use will allow facility more clinical flexibility or will mor accurately capture therapy and other treatments.