Maintenance coverage
Medicare cover for skilled care that will not improve the patient, but prevents deterioration or preserves what they have.
What it means
The rule is explicit: restoration potential is not the deciding factor in whether skilled services are needed.
Even where full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or to preserve current capabilities.
What still has to be shown is that the service is genuinely skilled, and the showing is made in the medical record.
Why it matters
The belief that cover stops when a patient stops improving is repeated at care-planning meetings across the country, and it is not the rule.
Knowing the rule is what lets a family ask for the right thing — documentation — rather than argue about progress.
When you are likely to meet it
- When a therapist says a parent has plateaued and therapy is ending.
- When home health visits are being reduced because there is no further progress.