Coverage does not turn on the presence or absence of potential for improvement but rather on the need for skilled care. Skilled maintenance therapies and nursing are covered by Medicare. Claims should never be denied because patient cannot achieve complete independence in self-care or cannot be expected to return to prior level of functioning.
Jimmo applies to Skilled Nursing Facility, Home Health, Outpatient Therapy (PT, SLP/ST, OT) and Inpatient Rehabilitation Hospital (Facility) (IRF). Services can be skilled and covered when:
- Needed to maintain, prevent, or slow decline or deterioration;
- A skilled professional is needed to provide or supervise to ensure services are safe and effective.
CMS revised Medicare policy manuals, guidelines, and instructions to reflect these principles per the Court approved settlement.