CMS Revises Medicare Policy to Ensure Coverage for Skilled Maintenance Care

December 10, 2013
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) have announced that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement. The Jimmo case ended a longstanding practice denying Medicare coverage to people who  had “plateaued,” or were “chronic,” or “stable,” or “not likely to improve.” The Manual revisions clarify that improvement is not required to obtain Medicare coverage and the revisions pertain to care in Skilled Nursing Facilities (SNF), Home Health care (HH), and Outpatient Therapies (OPT) as well as a Medicare beneficiary does not need to return to their prior level of function for services to be covered in an Inpatient Rehabilitation Facility (IRF). This is important information that providers of therapy services need to read and understand. To access the 118 page document released by CMS, click

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