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Jimmo v. Sebelius Settlement: – Will There Be More Opportunity for Continued Therapy?

July 12, 2013 0 Comments

Physical therapist with senior woman climbing stairsTherapists are beginning to question how the Jimmo vs. Sebelius (HHS/CMS) lawsuit might affect their therapy practice.  Therapists are thinking of those patients who make very small, and steady improvement, or patients who have chronic conditions that need therapy frequently in order to maintain independence. Or contemplating their patients residing in independent living apartment apartments whose ability to remain there (rather than an assisted living facility or skilled facility) is dependent on intermittant treatment by physical and occupational therapists?

According to the CMS Fact Sheet on the Settlement:

The settlement agreement is intended to clarify that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration. As such, any actions undertaken in connection with this settlement do not represent an expansion of coverage, but rather, serve to clarify existing policy so that Medicare claims will be adjudicated consistently and appropriately.

CMS has until January of 2014, as required under the settlement to update manual instructions and provide training to the Medicare Administrative Contractors (MACs), issue Medicare Learning Matters article, Medicare 1-800 number call scripts, and well as educate adjudicators and the providers.  Stay tuned.  Do you have patients that may benefit?

Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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