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  • CMS Issues Information on Skilled Therapy Services and Maintenance Care

    The Centers for Medicare and Medicaid Services (CMS) has issued revised portions of the Medicare Benefits Policy and Claims Processing manuals to clarify coverage of skilled therapy services in maintenance care. The revisions were mandated as a result of the Jimmo v Sibelius settlement agreement reached in US District Court earlier this year.

    In the transmittal (.pdf), CMS reiterates its longstanding policy that skilled therapy services still may be covered even in situations where no improvement is possible, including when skilled services are needed to prevent deterioration. The transmittal also contains information on the documentation necessary for coverage determinations in skilled maintenance therapy.

    APTA is reviewing the transmittal and will provide a detailed summary in the coming days.

    Join CMS from 2:00 pm to 3:00 pm December 19 for a Medicare Learning Network conference call on how the Jimmo v Sibelius agreement will affect the services provided by physical therapists. Registration is open now, but spaces are likely to fill up quickly.


    • Please register me

      Posted by Mary jo Mincks on 12/10/2013 8:24 PM

    • I assume this ruling only applies to PT In a skilled nursing facility. Any idea how it would play out in out pt RE" Parkinson's patients.

      Posted by James Dagostino on 12/11/2013 10:49 AM

    • The Jimmo settlement applies to Medicare patients treated by PTs in the home health, inpatient rehabilitation facility, skilled nursing facility, and outpatient therapy settings, so it would also apply to patients with Parkinson disease and other conditions treated in these settings. If skilled therapy services are needed to prevent or slow decline in the patient's condition, the Medicare contractor cannot deny coverage based on the fact that the patient's condition will not improve.

      Posted by News Now on 12/12/2013 10:05 AM

    • This ruling applies to all Medicare beneficiaries regardless of setting. Am reading the manual updates now and finding many items that will need clarification and education!

      Posted by Tamera Kelly -> >GW`C on 12/12/2013 3:02 PM

    • If client resides in alf and alf caregivers are not permitted to provide contact guard A. can client be continued on maintenance therapy indefinitely for walking? This client unsafe to I amb , however is I all transfers and i amb few feet to toilet. With CGA can walk max 200 feet. Client has brother. Brother is busy unable to walk client Does the presence or absence of capable caregivers Make a difference. .?

      Posted by Heather on 4/1/2014 1:29 PM

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