In January 2014, the Centers for Medicare and Medicaid Services (CMS) 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 January transmittal, CMS reiterated its longstanding policy that skilled therapy services still may be covered even in situations where no improvement is expected, including when skilled services are needed to prevent deterioration. The transmittal (.pdf) also contains information on the documentation necessary for coverage determinations in skilled maintenance therapy.
APTA staff presented a webinar titled Defining Skilled Maintenance Therapy and Minimizing Denials webinar on April 24, 2014. Review answers to the frequently asked questions (FAQs) that came up during the webinar. For further information or answers to other questions you may have, please e-mail firstname.lastname@example.org.