Medicare Benefit Policy Manual, Chapter 8 – Skilled Nursing Facility Services
Section 30
Coverage of nursing care and/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 and/or therapy, but rather on the patient’s need for skilled care.
Section 30.2.1 Skilled Services Defined
Skilled care may be necessary to improve a patient’s current condition. To maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.
Section 30.3 (Nursing)
… Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided, … Coverage does not turn on the presence or absence of an individual’s potential for the improvement from nursing care, but rather on the beneficiary’s need for skilled care,
Section 30.4 (Therapy)
Coverage for such skilled therapy services does not turn on the presence or absence of a beneficiary’s potential for improvement from therapy services, but rather on the beneficiary’s need for skilled care. Therapy services are considered skilled when they are so inherently complex that they can be safely and effectively preformed only by, or under the supervision of, a qualified therapist (See 42 CFR §409.32) These skilled services may be necessary to improve the patient’s current condition, or to prevent of slow further deterioration of the patient’s condition.