The Centers for Medicare and Medicaid Services Issues Updates to Medicare Benefit Policy Manual

In order to comply with a January 2013 settlement agreement in a federal lawsuit, The Centers for Medicare and Medicaid Services (CMS) issued updates to its­­­ Medicare Benefit Policy Manual, the program manual used by Medicare contractors, to clarify that skilled nursing services and skilled therapy services are not contingent on an individual’s potential for improvement.  For some time, providers of Medicare home health services relied on an improvement standard to determine eligibility for skilled nursing or therapy services.  CMS has clarified in its program manual update that the need for skilled services must be based on medical necessity not the potential for improvement.  The manual states that skilled services may be needed by an individual to improve a current condition, to maintain a current condition, or to prevent or slow further deterioration of a condition.

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