The following is an excerpt from a May 28, 2024 article in McKnight’s Long Term Care by Jean Wendland Porter, Regional Director of Therapy Operations at Diversified Health Partners in Ohio.
“I don’t want to risk my license by continuing therapy for her when she’s not making progress. She has plateaued.” … a response from one of my staff when our Medicare client wanted to continue skilled therapy at a maintenance level. Years of misinformation and widespread therapy mythology led her to believe that her professional license dictated that her clients make progress.
Half of my professional life has been explaining and educating my staff and the wider skilled nursing community that progress is not required for therapy to continue. In the actual Medicare Manual, it is stated that Medical Appropriateness does not turn on whether the patient will significantly improve…
“Coverage of nursing care and/or therapy to perform a maintenance program does not turn on the presence or absence of an individual’s potential for improvement from the nursing care and/or therapy, but rather on the beneficiary’s need for skilled care.”
One would think that this issue would have been resolved in 2013 with the Jimmo v. Sebelius decision
Thank you, Ms. Porter! Read the full article at McKnights.com