Skilled Nursing and therapy to maintain an individual’s condition are covered by Medicare. Improvement is not required. This applies to Medicare Advantage as well as traditional Medicare.
CMS wrote in the 2/13/2024 memo “Reminder: Jimmo Settlement Coverage and Training” that they were supplying the information for Medicare Advantage Organizations (MAOs) regarding the Jimmo Settlement “to use to refresh and/or train staff and contracted providers to ensure MA services are provided – and organization determinations and reconsideration are adjudicated accurately and appropriately…” The memo went on to say:
The Centers for Medicare & Medicaid Services (CMS) reminds MAOs [Medicare Advantage Organizations] of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). [Emphasis added.]
See the resources at
at https://www.cms.gov/medicare/settlements/jimmo