Medicare has expanded coverage to include skilled maintenance services. Under the new policy, Medicare can no longer deny coverage solely because a beneficiary is "not improving" and will now cover skilled nursing and therapy services that are necessary to maintain a person's condition. Beneficiaries who were previously denied skilled nursing facility care, home health care, or outpatient therapy services may request a time-sensitive re-review from CMS.

1. WHAT
YOU
NEED
TO
KNOW
THAT’S
NEW
ABOUT
MEDICARE
CMS
WILL
COVER
SKILLED
MAINTENANCE
SERVICES!
Coverage
is
now
available
for
beneficiaries
who
need
skilled
maintenance
care
and
meet
other
qualifying
criteria.
Medicare
can
NO
LONGER
deny
coverage
because
a
beneficiary
is
“not
improving.”
New
policy
provisions
will
state
that
“skilled
nursing
and
therapy
services
are
necessary
to
maintain
a
person’s
condition
and
can
be
covered
by
Medicare.”
Discuss
the
Medicare
maintenance
standard
with
your
physiatrist
and
whether
it
is
applicable
to
you.
Health
care
providers
should
apply
the
maintenance
standard
and
provide
medically
necessary
nursing
services
or
therapy
services,
or
both,
to
patients
who
need
them
to
maintain
their
function,
or
prevent
or
slow
their
decline.
If
you
were
denied
skilled
nursing
facility
care,
home
health
care,
or
outpatient
therapy
services
(occupational
therapy,
physical
therapy,
or
speech
therapy),
CMS
has
a
time-­sensitive
process
of
"re-­review"
for
Medicare
beneficiaries.
For
more
information,
go
to
http://www.medicareadvocacy.org/