- Medicare coverage turns on whether skilled care is required, not on improvement
- Restoration is not the deciding factor
- Medicare is available for skilled care to maintain a patient’s condition or slow decline
- An individual assessment must be made of each individual’s qualification for coverage
- This applies to skilled nursing facility, home health, outpatient therapy, and to a certain extent, inpatient rehabilitation facility care
“This is long-standing criteria, consistent with regulation.” – See the CMS Important Message About Jimmo