Medicare IS available for skilled care to maintain or slow decline of an individual’s condition.
“Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities.”
• 42 C.F.R. § 409.32(c)
Maintenance nursing is a Medicare-covered service if nurse needed to provide or supervise care.
- E.g., observation & assessment by a skilled nurse when there is a “reasonable probability” for a complication or acute episode, even if it does not occur.
• Medicare Benefits Policy Manual, Ch. 8, §30.2.3.2 Ex. 6
“Maintenance Therapy – Therapy services in connection with a maintenance program are considered skilled when they are so inherently complex that they can be safely and effectively performed only by, or under the supervision of, a qualified therapist. … Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary’ requires skilled care for the safe and effective performance of the program.”
• Medicare Benefit Policy Manual, Chapter 8, §30.4.1.2.E