Blue Cross and Blue Shield of New Mexico reminds providers that skilled nursing care and skilled therapy services may be covered under the Blue Cross Medicare AdvantageSM plan.
Medicare covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health and outpatient therapy benefits.
As outlined in the Jimmo Settlement, coverage of these services does not depend on expectations for improvement.
Skilled Nursing Care
- Services are covered when they are necessary to maintain the member’s current condition, slow decline or prevent deterioration, so long as the member requires skilled care for the services to be safely and effectively provided.
Skilled Therapy Services
- Services are covered when an individualized assessment of the member’s clinical condition demonstrates that a skilled therapy program is necessary to maintain the member’s current condition, slow decline or prevent deterioration, so long as the member requires skilled care for the safe and effective performance of the program.
All other coverage criteria need to be met for these services.
Additional Information
The foregoing is neither a complete description of the Jimmo Settlement nor of the coverage criteria for the applicable services. You may wish, for example, to refer to Jimmo Settlement link above and Chapters 1, 7, 8 and 15 of the Medicare Benefit Policy Manual on CMS’s website for additional information.