Member Outreach on Improvement Standard Settlement

This is a reminder to members that the Centers for Medicare and Medicaid Services (CMS) has issued the program manual revisions arising out of the Jimmo vs. Sebelius “Improvement Standard” settlement. These revisions are summarized in MLN Matters article 8458. According to the CMS guidance, “No ‘Improvement Standard’ is to be applied in determining Medicare coverage for maintenance claims in which skilled care is required. Medicare has long recognized that even in situations where no improvement is expected, skilled care may nevertheless be needed for maintenance purposes (i.e., to prevent or slow a decline in condition).” This concept applies to both skilled nursing and therapy services. For skilled nursing facility and home health agency providers, this represents increased flexibility in providing residents/patients with Medicare Part B covered skilled care.

CMS held a teleconference on Thurs., Dec. 19 entitled, Program Manual Updates to Clarify SNF, IRF, HH, and OPT Coverage Pursuant to Jimmo v. Sebelius. The slides from this program are available by clicking here, and an encore recording should be posted soon. LeadingAge also posted information on the revisions, which are available here.

LeadingAge New York is planning an audio conference specifically geared for members, so please watch for the announcement coming soon or check the Leading-U website for additional details.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827