QUIZ: 2022 Maintenance Therapy

There are 2 types of maintenance programs:

Skilled and Non-Skilled

Medicare will only cover which one?

The Jimmo v Sebelius court case involved a patient that filed a lawsuit to fight the denial of Medicare coverage due to lack of progress for therapy treatment of a chronic progressive disease.

This Settlement Agreement reinforced the existing Medicare rules that patient progress is not required in order for therapy to be covered by Medicare in the SNF and other settings.

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 the facility interdisciplinary team, including therapy professionals, have a responsibility to make recommendations for each resident as needed to maintain highest level of function. These recommendations can include a skilled or a non-skilled maintenance program (ie: program completed by therapy and/or recommendations carried out by non-therapy professionals including caregivers, family, etc).

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)

Chapter 15 of the Medicare Benefit Policy Manual defines both Rehabilitative and Maintenance Therapy services under Part B.

What do they both have in common?

n Chapter 8 and Chapter 15 of the Medicare Benefit Policy Manuals, the “rules” for documentation of “Skilled Maintenance” therapy services for Medicare Part A and Medicare Part B are the same.

Each require weekly progress 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.

The determination that no anticipated progress would be achieved has to be made at the time of the therapy evaluation, and reflected in the assessment and goals.

Justification for the Maintenance Services is required.  Therapy services cannot be deemed “Maintenance” after-the-fact, if progress was expected and goals were not achieved.

Initially, when the Medicare Manuals were updated as a result of the Jimmo Settlement Agreement, there was a split decision on the provision of skilled maintenance therapy.

Medicare Part A regulations (Chapter 8) stated PTAs/OTAs could provide Skilled Maintenance Therapy.

Medicare Part B regulations (Chapter 15) stated that PTAs/OTAs were not allowed to provide Skilled Maintenance Therapy.

On January 1st, 2021, in the middle of the COVID-19 Public Health Emergency, this rule was permanently changed.

What is the current rule regarding Assistants providing Maintenance Therapy for Medicare Part A and Part B?

Skilled Maintenance Therapy is SKILLED therapy, even if it is to MAINTAIN a resident status.

Therefore, all documentation and billing rules that apply for both Medicare Part A and Part B residents, also apply to those receiving Skilled Maintenance Therapy.