The Centers for Medicare and Medicaid Services has announced it is updating some of its Medicare policy manuals pursuant to a recent settlement in Jimmo vs. Sebelius.
CMS is providing manual updates to clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) coverage requirements pursuant to the settlement of the case, the agency announced this week.
CMS states: “In accordance with the Jimmo v. Sebelius Settlement Agreement, the Centers for Medicare & Medicaid Services (CMS) has agreed to issue revised portions of the relevant program manuals used by Medicare contractors, in order to clarify that coverage of skilled nursing and skilled therapy services “…does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.”
The agency further specifies the changes in the notice published to its website.
Written by Elizabeth Ecker