The Post-Acute Care Guide to Maintenance Therapy

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The Post-Acute Care Guide to Maintenance Therapy

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The Post-Acute Care Guide to Maintenance Therapy

Cindy Krafft PT, MS and Diana L. Kornetti, PT, MA

On February 1, a federal judge ordered the federal government to take steps to comply with standards original set by Jimmo v. Sebelius. The federal government must educate Medicare Administrative Contractors (MAC) on the maintenance therapy standard with the understanding that therapy which maintains function or prevents or slows decline should be covered. Home health agencies can document maintenance therapy correctly and without fear using expert tools and guidance found in The Post-Acute Care Guide to Maintenance Therapy.

This guide contains both regulatory information and analysis as well as hands-on, practical advice for care and documentation. Advice given is specific to each post-acute care setting, including SNFs, home health, hospice, and rehabilitation. The guide also features tips from consultants, downloadable materials, and sample forms and worksheets for easy comprehension of information.

This book ensures Medicare coverage by:

  • Guiding providers through the documentation process related to maintenance therapy
  • Explaining how to document at key instances
  • Tips for defending medical necessity
  • Providing practical advice and information on how to identify patients who require maintenance therapy, conduct patient assessments, and write goals

After reading this book, readers will be able to:

  • Understand the proper use of maintenance therapy
  • Identify when and how to document care as maintenance therapy
  • Determine which patients qualify as needing maintenance therapy
  • Plan and assess care of maintenance therapy patients
  • Document maintenance therapy with confidence
  • Use the tools provided to help with comprehension and documentation

This book contains tips, tools, and resources on:

  • Identification of maintenance candidates
  • Goal writing strategies
  • Compliance with reassessment expectations
  • Care planning for the maintenance patient

Also included:

  • Documentation auditing tool

Judith Stein, a lead attorney on the Jimmo v. Sebelius case and executive director for the Center for Medicare Advocacy, has provided tools to help agencies better use maintenance therapy in their practice, including a Self-Help Packets for Home Health Care/Outpatient/Nursing Appeals, Including “Improvement Standard” Denials.

A specific scenario is used throughout to demonstrate key concepts. To enhance knowledge application, a practice scenario is provided as well.

About the Authors

Cindy Krafft, PT, MS, has more than 20 years of home health expertise that ranges from direct patient care to operational and management issues. For the past 10 years, she has been a nationally recognized educator in the areas of documentation, regulation, therapy utilization, and OASIS. Krafft has been involved at the senior leadership level for the Home Health Section of the American Physical Therapy Association (APTA) and is the current president of that organization. She has been working with APTA and CMS to clarify regulatory expectations and address proposed payment methodologies to ensure the long-term participation of therapy services in home health. Krafft has written two books: The How-to Guide to Home Health Therapy Documentationand An Interdisciplinary Approach to Home Care.

Diana L. Kornetti, PT, MA, a physical therapist for 30 years, is a former co-owner and administrator of a Medicare-certified home health agency in Florida and is the chief operations officer of Kornetti & Krafft Health Care Solutions. Kornetti is nationally recognized as a teacher and speaker in the areas of home health care, standardized tests and measures in the field of physical therapy, therapy training, and home health staff development. She has been an active member of APTA since 1986 and is its current Home Health Section program chair; immediate past editor of the Quarterly Report, a publication of the organization's Home Health Section; and a member of APTA's Practice and Education committees. Kornetti also serves as the president of the Association of Homecare Coding and Compliance, and is a member of the Association of Home Care Coders Advisory Board and Panel of Experts.


“As one of the lead attorneys in Jimmo v. Sebelius, I am delighted with The Post-Acute Care Guide to Maintenance Therapy. It is the perfect therapist’s companion to the Jimmo settlement and the revised Medicare polices that resulted from it . . . The Post-Acute Care Guide provides critical information to help therapists identify when skilled maintenance therapy is needed and how to document the therapy to support Medicare coverage.”

—Judith Stein, Executive Director/Attorney for the Center for Medicare Advocacy

Published: April 2015

Page count: 226
Dimensions: 8.5x11
ISBN: 978-1-55645-154-6

Table of Contents

By Judith Stein, a lead attorney on Jimmo v. Sebelius and executive director of the Center for Medicare Advocacy

Chapter 1 – Are We Providing Maintenance Therapy?

Chapter 2 – Defining Key Terms

  • Skilled
  • Reasonable
  • Necessary
  • Rehabilitation Potential

Chapter 3 – Understanding the Regulations

  • Qualifying Criteria
  • Coverage Criteria
  • Homebound Status

Chapter 4 – Identifying Maintenance Patients

  • Relevance of Diagnosis
  • Impact of Chronic Disease

Chapter 5 – Assessments and the Maintenance Patient

Chapter 6 – Goals—Capturing the Impact of Therapy

Chapter 7 – Care Planning With a Maintenance Focus

Chapter 8 – Defending Medical Necessity on Routine Visits

Chapter 9 – Reassessments in Maintenance Cases – Mandatory and Clinically Driven

Chapter 10 – Tips for Identifying Maintenance Patients

Chapter 11 – Tips for Qualified Therapists

Chapter 12 – Tips for the Quality Review Process


Appendix A: CMS Jimmo v. Sebelius Settlement Agreement Program Manual Clarifications Fact Sheet

Appendix B: The CMS MLN Matters: “Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo v. Sebelius

Appendix C: Jimmo v. Sebelius, the Improvement Standard Case FAQs

Appendix D: Self Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials

Appendix E: Self Help Packet for Home Health Care Appeals Including “Improvement Standard” Denials

Appendix F: Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials

Appendix G: Medicare Enrollment & Appeals Group’s Notification on Jimmo and Medicare Advantage Plans

Appendix H: Center for Medicare Advocacy: About Us