There has been a longstanding myth that Medicare does not cover services to maintain or manage a beneficiary's current condition when no functional improvement is possible. The recent Jimmo vs. Sebelius final settlement sought to dispel this fallacy and provide clarifications to safeguard against unfair denials by Medicare contractors for skilled therapy services that aid in maintaining a patient's current condition or to prevent or slow decline. Review background on skilled maintenance coverage under Medicare.
This page contains helpful resources on the applicable Medicare regulations regarding skilled maintenance therapy as well as practice applications on how to properly treat patients when providing skilled maintenance therapy services.
Several nonfederal payers also have clarified their policies regarding the improvement standard and skilled maintenance coverage. Read more about APTA's efforts with commercial payers, including a list of payers that have addressed the issue in their policies.
Important Message About the Jimmo Settlement
The US Centers for Medicare and Medicaid Services (CMS) provides more clarification on the Jimmo Settlement with new resources to its website. Review highlights via PT in Motion News.
Understanding What Defines "Skilled Maintenance"
Physical Therapist Practice in Skilled Maintenance
Legislative and Regulatory Activity