Maintenance Therapy

What is Maintenance Therapy?

Maintenance therapy is a covered benefit under Medicare's No Improvement Standard. By definition, Maintenance Therapy is when skilled intervention is necessary to prevent or slow a decline in function. To qualify for maintenance therapy, the "interventions must be so inherently complex that they cannot be taught to an unskilled person" or the patient's safety would be placed at risk if the interventions were performed by an unskilled person. A progressive disease condition does not automatically quality a patient.

Examples of Qualifying Criteria:

• Neuromuscular facilitation techniques for spasticity management (patient would be at risk for injury if performed incorrectly);

• Manual therapy for lymphatic drainage;

• Unstable vital signs which must be constantly monitored during treatment;

• Challenged balance activities which would place patient at risk for falls if done incorrectly.

What Does Not Qualify:

• Low motivation;

• The mere fact that a patient will decline due to noncompliance with HEP;

• Routine exercise performance for well-being.

Steps to Qualify a Patient for Maintenance Therapy

A recommendation for maintenance therapy should be a joint recommendation between therapist and assistant if applicable and requires pre-authorization through UR/QA review by Connie Bonis, MOTR/L, Director of Clinical Services

Step 1: Send a "HUCU message " to Connie in the EMR requesting chart review for maintenance therapy and documenting the clinical rationale to support the recommendation using the criteria described above.

Step 2: When approved, orders for maintenance therapy will be requested by the referring MD/NPP and a maintenance therapy case will be established by Admissions. Maintenance therapy cases are defined by the letter "M" and the discipline (for example, a maintenance therapy case for physical therapy will be "MPT")

Step 3: Discharge the rehabilitation case. Discharge reason will be maximum benefit from skilled rehabilitative care.

Step 4: Complete Maintenance Therapy Evaluation using the provided template(s by discipline. Program frequency is the minimum necessary to maintain (average is one visit per week). Goal outcomes will be to "maintain" versus to improve an impairment.

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Learn More...

If you have not already done so, please take the course sponsored by LifeCare through the Independent Therapist Alliance, "Maintenance Therapy - A BluePrint for Success and "Documentation - It's All About the Skill".