Updated Fact Sheet on Medicare Nursing Home Benefit

Medicare includes a nursing home benefit of up to 100 days following a qualifying hospital stay. The Medicare rehabilitation benefit is per spell of illness. On reason we say “up to” is because the Medicare benefit is a rehabilitation benefit and it ends when the need for skilled therapy ends. Historically, that meant Medicare coverage ended when a determination was made that the resident was no longer making progress. That, however, is not what federal law says, so in 2013, the Center for Medicare Advocacy and Vermont Legal Services sued the Centers for Medicare and Medicaid Services in federal court to enforce the maintenance therapy language in the Medicare law. Now, if anyone needs therapy to maintain or slow deterioration, the Medicare rehabilitation benefit cannot be terminated even if there is no improvement.

The Center for Medicare Advocacy recently updated its fact sheet on this issue and you can find it here. If you believe your Medicare benefit was improperly terminated, you can appeal that decision.