Medicare Maintenance Series – Maintenance therapy has recently been clarified by CMS as a result of the JIMMO vs. Sebelius class action lawsuit and settlement. CMS has differentiated maintenance therapy from restorative therapy and indicates in the updated Medicare Benefits Policy Manual sections that there is no expansion of therapy and nursing coverage, but rather a clarification of existing policy. CMS updated the provider community on Medicare maintenance therapy and nursing services on a National Provider Call on December 19, 2013, and provided educational material in advance of the call including the presentation slide deck, Medical Learning Network Article, as well as Transmittal 179 to the Medicare Benefits Policy Manual (originally released as Transmittal 175, then Transmittal 176).
Medicare Maintenance Therapy – Important Clarification on Assistants
CMS provided clarification last week on the use of therapy assistants (physical therapist assistants and occupational therapy assistants) in skilled nursing facilities that clarified confusion of the National Provider Call presentation suggesting that assistants cannot provide maintenance therapy. As a result of the clarification that assistants (PTA and COTA) can provide maintenance therapy in skilled nursing settings, CMS updated the instructions to the Medicare Benefits Policy Manual (CR8458), and released Transmittal 179.
Transmittal 176, dated December 13, 2013, is being rescinded and replaced by Transmittal 179, to correct an error in Chapter 8, Section 220.127.116.11. The revisions in Transmittal 176 incorrectly indicated that skilled physical therapy services in the skilled nursing facility (SNF) setting must “…require the skills of a qualified therapist (not an assistant) for the performance of a safe and effective maintenance program.” The regulations under 409.32(a) and (b) do not specify that an assistant cannot perform maintenance services in the SNF setting, unlike the home health and outpatient regulations which do make that distinction. Therefore, this updated transmittal corrects that particular language to eliminate the phrase “(not an assistant)”. All other information remains the same.
CMS had indicated the reason for the differentiation of the use of therapy assistants in providing maintenance coverage was provided in this fashion to be consistent with the varying regulations for outpatient therapy providers in the use and supervision of assistants. Outpatient therapy providers and home health providers, as clarified by CMS may not utilize therapy assistants to provide covered maintenance therapy to Medicare beneficiaries.
Has your practice reviewed the updated sections of the Medicare Benefits Policy Manual? Are you prepared for the patient that comes to request “maintenance” therapy?