Jimmo correction: Assistants may provide maintenance services in skilled nursing facilities

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Skilled nursing facilities may be reimbursed for maintenance therapy services performed by assistants, the Centers for Medicare & Medicaid Services clarified in a recent Medicare Benefit Policy manual revision. CMS officials announced and explained the revision in an Open Door Forum call Thursday.

CMS recently updated the manual to make it clearer that Medicare may reimburse for skilled nursing services meant to maintain, not improve, a beneficiary's condition. The agency was required to make these updates per the settlement in the Jimmo v. Sebelius case.

In making the updates, CMS attempted to use language that would apply to all three settings where maintenance therapy might occur: skilled nursing facilities, outpatient therapy clinics and home health settings. This led to an “inadvertent” error that caused confusion for providers, officials on the ODF call acknowledged.

The error occurred in a sentence that stated a maintenance therapy program would require the skills of a “qualified therapist (not an assistant).” The assistant exclusion applies for home health and outpatient providers but not SNFs, said Jeanette Kranacs, director of CMS' Division of Institutional Post Acute Care.

The manual language now has been corrected, as explained in a Jan. 14 transmittal.

Kranacs apologized for the error.

Officials on the call also fielded several questions from providers regarding the Medicare Advantage program. The callers expressed ongoing confusion related to MA coverage and dissatisfaction with the responsiveness of MA administrators to their questions.

A future Open Door Forum might include Medicare Advantage experts to address these questions, a CMS official on the call suggested.

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