Thursday December 12, 2013
In the regulations at42 CFR 409.32(c), the level of care
criteria for SNF coverage specifies that the "… restoration
potential of a patient is not the deciding factor in determining
whether skilled services are needed." In addition, on January 24,
2013, the Court approved the settlement concerning the Jimmo v.
Sebeliuscase which has eventually resulted in new guidelines for
skilled care and skilled therapy.
The Centers for Medicare & Medicaid Services has now
revised the Medicare Benefit Policy Manual, Publication #: 100-02,
Chapter 8, § 20.1.2-Determination of Coverage, to clarify that
skilled care and skilled therapy may be covered even for conditions
that will not improve.
In the past many thought that Medicare coverage of skilled
nursing care or therapy required documentation that a resident or
Medicare beneficiary must have the potential for improvement from
the nursing care or therapy. The manual revisions, now
clarifies that skilled care may be needed to maintain a current
condition or prevent or slow a resident/patient's deterioration.
The manual also includes specific examples of documenting skilled
Until theMedicare Benefit Policy Manualis updated, see the
attachedMLN Matters Number: MM8458 or Related CR Transmittal #:
R175BP. Effective Date: January 7, 2014,for guidance.
Please click on the MLN Matters article below: