CMS has issued its first official statement on how it will implement the class action settlement to end Medicare’s “improvement standard.”
 
“Any actions undertaken in connection with this settlement do not represent an expansion of coverage, but rather, serve to clarify existing policy so that Medicare claims will be adjudicated consistently and appropriately [emphasis added by CMS],” CMS notes in the fact sheet, published April 4.
 
CMS says it will take the following actions to implement the settlement:
  • Clarify coverage language in the manuals. The new manual language will clarify that therapy coverage “does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.”
  • Launch an educational campaign for contractors, adjudicators and providers. As part of the campaign, CMS will issue transmittals and MLN Matters articles, as well as conduct national conference calls.
  • Conduct a claims review. CMS will review a “random sample” of home health coverage decisions “to determine overall trends and identify any problems.”
 
The manual revisions and educational campaign will be completed by Jan. 23, 2014, which is within one year of the date the settlement was approved, CMS notes.