QUIZ: 2023 Maintenance Therapy

A maintenance program can be considered skilled or non-skilled. Medicare will cover  which one?

The Jimmo v Sebelius court case settlement [patient filed lawsuit to fight denial of Medicare coverage for therapy treatment of a chronic progressive disease due to lack of progress and won] reinforced the existing Medicare rules that patient progress is not required in order for therapy to be covered.

Survey  F Tag 675: Quality of Life states: “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psycho-social well-being, in accordance with the comprehensive assessment and plan of care.”

This statement implies that therapists are responsible for making recommendations (ie: setting up a maintenance plan) for each resident to maintain highest level of function. 

The following statements are true:

• Medicare only pays for “skilled care,” regardless of Medicare type – Medicare Part A and Medicare Part B
• All payment is based on providing SKILLED SERVICES…or services that require the SKILL of the NURSE or THERAPIST and cannot be provided by non-skilled professionals

Which of the following could be types of Skilled Maintenance programs? (Select all that apply)

Part B defines both Rehabilitative and Maintenance Therapy services. What do they both have in common?

The “rules” for documentation of “Maintenance” services for Medicare Part A and Medicare Part B are the same. Each require weekly notes.

“Skilled Maintenance” is actually “Skilled Therapy” services provided to a resident with no anticipated progress due to the resident’s condition, but the skills of a therapist are needed to assess, design and implement a program.

When the Medicare Manuals were updated as a result of the Jimmo Settlement Agreement, Medicare Part A regulations stated PTAs/OTAs could provide Skilled Maintenance Therapy. However, Medicare Part B regulations stated that PTAs/OTAs were not allowed to provide Skilled Maintenance Therapy. On January 1st, 2021, this rule was changed. What is the current rule regarding Assistants and Maintenance Therapy?

Skilled Maintenance Therapy is SKILLED therapy, even if it is to MAINTAIN a resident status. Therefore, all documentation and billing rules apply for both Part A and Part B residents receiving Skilled Maintenance Therapy.