• MLN Matters Number - MM8458

    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 care.


    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:

    MLN Matters Number - MM8458


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