CHA News Article

CMS Revises Sections of Medicare Benefit Manual Due to Settlement Agreement

To clarify coverage policies following a recent settlement agreement, the Centers for Medicare & Medicaid Services (CMS) has revised portions of its Medicare Benefit Policy Manual on services provided by skilled-nursing facilities, inpatient rehabilitation facilities, home health agencies and outpatient therapy. Based on the settlement agreement, Jimmo v. Sebelius, CMS Transmittal 176 specifies that standards requiring potential for improvement may not be applied as a rule of thumb to determine Medicare coverage for services that require skilled-nursing care or skilled therapy services.  It also provides guidance on appropriate documentation. CMS notes that the transmittal, attached, does not represent an expansion of benefits or a change in Medicare’s longstanding policy on the need for skilled-nursing care and skilled-therapy services.