Coverage does not turn on the presence or absence of potential for improvement but rather on the need for skilled care. Services can be skilled and covered when:
- Needed to maintain, prevent, or slow decline or deterioration;
- Skilled professional is needed to provide or supervise to ensure services are safe and effective.
CMS revised Medicare policy manuals, guidelines, instructions to reflect these principles per Court approved settlement.
A clear message from CMS is available at https://www.cms.gov/medicare/settlements/jimmo.