The Code of Federal Regulations:
“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)
The Medicare Benefits Policy Manual:
Maintenance nursing is a Medicare-covered service if nurse needed to provide or supervise care.
Medicare Benefits Policy Manual, Ch. 8, §18.104.22.168 Ex. 6
- 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.
“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, §22.214.171.124.E