Medicare home health coverage is misunderstood and too often denied. This is particularly true for people with longer-term and chronic conditions who are unable to obtain Medicare coverage although they meet the benefit’s criteria – are homebound and require skilled nursing and/or therapy. The Jimmo settlement, federal regulations, and Medicare’s own Benefit Manual make this clear:
“…Coverage of skilled nursing care or therapy to perform a maintenance program does not turn on the presence or absence of a patient’s potential for improvement from the nursing care or therapy, but rather on the patient’s need for skilled care. Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, to prevent or slow further deterioration of the patient’s condition.” (Medicare Benefit Policy Manual (MBPM), Chapter 7, Section 20.1.2.)
See: Quick Guide; Home Health Graphic; MBPM Chapter 7, Section 40.1.1 and 40.2.2.E; and CMS.gov/Special Topics/Jimmo Settlement