PA - Raser, Terry

Regarding the below section of the regulation there has been confusion in the industry regarding COTs when a residents MDS RUGs into a nursing RUG due to index maximization eventhough the resident is receiving therapy. Please clarify if the resident receiving enough days and minutes of therapy to have a therapy RUG but index maximizes into a nursing RUG for payment requires the 7 day COT count to continue or does the nursing RUG stop the COT 7 day count until the next intevening therapy RUG? MDS 3.0 Changes In the FY 2012 SNF PPS final rule, we introduced a new assessment called the COT OMRA to capture more accurately the therapy services provided to SNF residents. Effective for services provided on or after October 1, 2011, SNFs are required to complete a COT OMRA for patients classified into a RUG-IV therapy category (and for patients receiving therapy services who are classified into a nursing RUG because of index maximization), whenever the intensity of therapy changes to such a degree that it would no longer reflect the RUG-IV classification and payment assigned for the patient based on the most recent assessment used for Medicare payment (76 FR 48525).