Is Your Patient Appropriate for Maintenance Care?

Most home health care providers are familiar with Jimmo v. Sebelius (2013) and understand this case defined and solidified the use of maintenance care in home health.  However, many home health providers, most often providing restorative care, write their documentation and care planning for restorative care and maintenance care all the same.  This is a mistake because restorative care plans by definition have outcomes and goals the patient is working to reach while maintenance plans do not. If your care plan has the patient working toward improvement of any kind, it is a restorative care plan.

Agencies often feel maintenance care is targeted for audits, but it is frequently the extended length of stay prompting maintenance care to be questioned. Since maintenance care requires a longer length of stay home health agencies should expect audits and understand it is important to document to the maintenance of the patient only. 

Since home health agencies often mistakenly use restorative care plans on maintenance patients, maintenance patients have a very high rate of denial. The restorative language basically disqualifies them from being considered “maintenance care” and evokes the  “reasonable and necessary” clause from the Medicare Benefit Policy Manual Chapter 7, 40.1 & 40.2.

Below is a guide to qualifying patients for maintenance care:

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