Manual Updates to Clarify SNF Coverage Pursuant to Jimmo (MLN Matters)

As you are aware from our December blog post, Medicare Program Manual Updated Based on Jimmo decision, the Medicare Program Manual was updated to reflect that there is no “improvement standard” that can be applied to determine coverage for claims in which skilled nursing care is required. MLN Matters released an article on January 14, 2014 (updated on January 15, 2014), “Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius.” This document reflects all of the points that were discussed on the Open Door Forum call that took place in December, including:

  • No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims in which skilled care is required
  • Enhanced guidance on appropriate documentation

View MLN Matters Article #MM8458 here.

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