Improvement Standard definition

Improvement Standard refers to a standard that Plaintiffs have alleged, but that Defendant denies, exists under which Medicare coverage of skilled services is denied on the basis that a Medicare beneficiary is not improving, without regard to an individualized assessment of the beneficiary’s medical condition and the reasonableness and necessity of the treatment, care or services in question.

Split View

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Get StartedBook a Demo

Improvement Standard is to be applied in determining Medicare coverage for maintenance claims that require skilled care. • Skilled nursing or therapy services are covered where such services are necessary to maintain the patient’s current condition or prevent or slow further deterioration safely and effectively. • Restorative Services – These are services whose purpose is to reverse, in whole or in part, a previous loss of function. In evaluating a claim for skilled services that are restorative in nature (or “Rehabilitative Therapy” in the OPT setting), it would be appropriate to consider the beneficiary’s potential for improvement from the services. • This standard applies whether restorative skilled nursing or skilled therapy is provided in the SNF or HH settings. It would also be the case in the IRF setting and for Rehabilitative Therapy in the OPT setting, where the goal of treatment is restoring function. • Maintenance Services – These are skilled nursing or therapy services necessary to maintain the patient’s condition or to prevent or slow further deterioration. There may be specific instances in the SNF, HH, and OPT settings where, even though no improvement is expected, the skills of a qualified therapist, registered nurse, or (when provided by regulation) a licensed practical nurse are required to perform a type of service that would otherwise be unskilled because of the patient’s special medical complications, as well as when the needed services are of such complexity that only such a practitioner can perform it safely and effectively. • In evaluating a claim for skilled maintenance nursing or therapy, coverage does not turn on the presence or absence of an individual’s potential for improvement, but rather, on the beneficiary’s need for skilled care, along with the underlying reasonableness and necessity of the services themselves. Any Medicare coverage or appeals decisions concerning skilled care coverage must reflect this basic principle. • On December 6, CMS published revisions to the following relevant portions of the Medicare Benefit Policy Manual (MBPM): – Chapter 7 – Home Health (HH) – Chapter 8 – Skilled Nursing Facility (SNF) – Chapter 15 – Outpatient Therapy (OPT) • Revisions clarify that, in the maintenance context, coverage of skilled nursing and skilled therapy services “…does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” • On December 6, CMS also published rev...

Improvement Standard. The Court never ruled on the validity of the ▇▇▇▇▇ plaintiffs’ allegations.

Examples of Improvement Standard in a sentence

• In the event of a failure to improve performance, in the view of the local authority, to the equivalent of a Satisfactory/Requires Improvement Standard within 6 months of an Ofsted inspection resulting in a Satisfactory /Requires improvement judgement or less (unless Ofsted have re-inspected the Provider and have issued a new Inspection Judgement of Satisfactory/Requires Improvement standard or above) will result in withdrawal of funding and removal from the Directory.

• The Preliminary Space Plan shall conform to the Tenant Improvement Standard.

• With respect to the tenant improvements, if the Additional Space is to be finished by the Landlord under the Refusal Notice, such Additional Space shall be finished at no additional cost to Tenant in a manner and style substantially equivalent to the initial Premises (which manner and style is referred to as the “Initial Improvement Standard”), and Tenant shall be responsible for any desired modifications or further improvements to the Additional Space beyond the Initial Improvement Standard.

• The Contractor shall carry, at a minimum, insurance as specified in Section I B, Public Improvement Standard Conditions.

• Within five (5) Business Days after receipt of such Revised Plans or Revised Budget, as the case may be, the receiving party shall approve in writing or disapprove the Revised Plans or Revised Budget, as the case may be, with specific written objections to same, in accordance with the Tenant Improvement Standard or Building Standard, as the case may be.

• Landlord shall deliver to Tenant at the conclusion of the walk-through a list of any items not completed in accordance with the Lease, Work Letter, construction documents, construction contracts, Building/Tenant Improvement Standard for Pacific Corporate Park as set forth in Exhibit "D" ("Building Standards") and/or other applicable codes, laws, regulations or standards ("Corrections List").