The dust may still be settling from Tuesday’s release of a new nursing home payment rule, but a leading trade group was already expressing concern Wednesday over what it sees as micromanagement of the field.

The Centers for Medicare & Medicaid Services issued its final rule for paying skilled nursing providers Tuesday afternoon. Providers will see an $820 million raise for fiscal 2019, which begins Oct. 1. That’s a result of the 2.4% market basket update that was spelled out in the Bipartisan Budget Act of 2018.

Various experts said Wednesday that the rule remained largely as it was first proposed in late April.

On the positive side, American Health Care Association President and CEO Mark Parkinson said in a statement Wednesday that the 2.4% boost is “essential for struggling providers as they prepare for the healthcare needs of an aging population.”

He added, however,  that providers should be concerned about terms that the administration is using to introduce the rule.

“The therapy language in the rule criticizes skilled nursing providers for providing therapy when CMS has promulgated rules over the last 20 years that encourage therapy,” Parkinson said. “Providing therapy to residents in our centers has been a good thing and it has resulted in millions of residents getting better and returning home.”

The AHCA and National Center for Assisted Living — the nation’s largest association of skilled nursing centers, assisted living facilities and other such providers — are worried that CMS may be taking too hands-on of an approach in moving its members toward value-based care.

“Rather than focusing on outcomes associated with therapy delivery as we requested, this rule micromanages patient care and therapy minutes at a time when providers are already overburdened by unnecessary regulation,” Parkinson continued. “For example, the rule sets an arbitrary 25% limit on concurrent and group therapy. Decisions about how much therapy is provided should not be made from a government office. Clinicians and patients should make those decisions together.”

Meanwhile, LeadingAge, in its own statement Wednesday, expressed optimism for what comes next, along with worries about some murkiness in the final rule.

“We are supportive of a payment system that accurately reimburses for the needs of residents,” said Katie Smith Sloan, president and CEO of LeadingAge. “CMS clarified some areas of concern in the final rule but many questions remain about the implementation and impact of this new model.”

Cynthia Morton, executive VP of the National Association for the Support of Long Term Care, told McKnight’s that there were no substantive changes in Tuesday’s rule.

She identified two switches of note, however. First, instead of using the ICD-10 PCS code in the second line of item I8000 on the MDS, for patient classification purposes, CMS will require to select as necessary a surgical procedure category in a sub-item within J2000 of the MDS, which would identify the relevant surgical procedure that occurred during the patient’s preceding hospital stay and which would augment the patient’s PDPM clinical category.

Second, CMS did make a change with the Interim Payment Assessment, now making that optional for providers.  “They noted there was confusion with the proposed policy” and decided to change it, she explained.