The Jimmo v. Sebelius settlement agreement came about in 2013 when the US District Court for the District of Vermont approved a settlement between the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare Advocacy (CMA). In a nutshell, CMA’s position was that Medicare beneficiaries were being denied skilled care because of …
Palmetto GBA updated their PT and OT local coverage determinations (LCDs) on 3/12/15 to include provider education and guidance regarding documentation of restorative versus maintenance therapy. The PT utilization guideline states “Whether the plan is rehabilitative/restorative or maintenance should be indicated on the CMS-485 or on the OASIS M1800-M1910 with reference to ADL/IADL’s and current …
The biggest mistake in home health care is our treatment of maintenance therapy as a separate and incomprehensible monster distinct from traditional rehabilitative therapy treatment. The truth is, there is little mystique when it comes to the home health maintenance therapy documentation. At its core, the same rules apply. Is it reasonable? Is it necessary? …
In October, 2012, the settlement agreement in the Jimmo v. Sebelius class action lawsuit was reached. The plaintiffs in this case were seeking to challenge denials of Medicare claims based on lack of progress in patient therapy care. This settlement agreement revises the accepted industry definition of covered services and opens up conversation and debate about maintenance …
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