The Centers for Medicare and Medicaid Services (CMS) recently issued a transmittal that makes changes to the home health provisions contained in the Medicare Benefits Policy Manual (Pub 100-02, Chapter 7) based on the Calendar Year 2011 Final Rule for Home Health.
Of importance to physical therapists are the sections on the general principles governing reasonable and necessary services and the application of the principles to physical therapy services. Under general principles (section 40.2.1), CMS discusses the process for determining whether individual therapy services are skilled and whether, in view of the patient's overall condition, skilled management of the services provided is needed. This section outlines how the assessment, measurement, and documentation of therapy effectiveness must support the necessity of services. In particular, the transmittal provides guidance on restorative therapy and also on designing or establishing a maintenance program.
Section 40.2.2 illustrates how the general principles apply to the provision of physical therapy services related to the assessment; therapeutic exercise; gait training; maintenance therapy; hot packs, infra-red treatments, paraffin baths, and whirlpool baths; and wound care provided within scope of practice acts. Examples are provided for selected interventions.
The therapy provisions for this rule are effective April 1.