Revised Skilled Nursing Facility ABNs

As providers are aware, the settlement in the Jimmo v. Sebelius lawsuit eliminated the “Improvement Standard” as a perquisite to qualifying for Medicare covered therapy services.  Revisions of the Centers for Medicare and Medicaid Services (CMS) Medicare policy manual related to the Jimmo v. Sebelius “Improvement Standard” settlement took effect Jan. 7, 2014. With the publication by CMS of these revisions and official guidance, it is clear that this represents a significant and important clarification of the scope of Medicare skilled coverage. CMS summarizes these revisions in MLN Matters article 8458. More information on the revisions can also be found on the LeadingAge NY website by clicking here.

In order to comply with their manual revisions, CMS is also updating the language to be used in the Skilled Nursing Facility Advance Beneficiary Notices (SNF ABN).  Correctly managing the ABN process and compliance with all the manual requirements, including the use of accepted language, is critical in order to ensure beneficiary rights and avoid provider liability.  These paragraph language revisions can be found in CMS Transmittal 2911.

LeadingAge NY is recommending that members access the CMS transmittal and ensure that you are in compliance with the changes.

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