Long term care Restorative Nursing programs will see some big changes with the expansion of Medicare to cover Maintenance Therapy.
“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.” CMS announced this week.
“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 concept of skilled therapy services can similarly involve not only services that are restorative in nature but, if certain standards are met, maintenance therapy as well.”
Maintenance Therapy is justified, says CMS, to prevent or slow a decline in condition.
Previous standards required that skilled nursing services result in an improvement to a resident’s condition to qualify for Medicare reimbursement.
Maintenance Therapy and Restorative Nursing Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage, Department Of Health And Human Services, Centers for Medicare & Medicaid Services, Implementation Date: January 7, 2014
