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[quote=Anonymous][quote]Question: Are there time limits for the coverage of skilled nursing and skilled therapy services?

Answer: The Jimmo Settlement does not include any time limits for Medicare coverage.  The rules for the health care settings covered by Jimmo vary.

For home health, as long as the skilled nursing or skilled therapy services are necessary to maintain the patient’s functioning or to prevent or slow the patient’s decline or deterioration, there are no time limits to home health care.  Medicare beneficiaries are entitled to ongoing coverage, which may last years, as long as all coverage criteria are met.

There are similarly no time limits for outpatient therapy.  Medicare has therapy “caps” for payment for covered services, but there is an exceptions process that authorizes coverage for medically necessary therapy services that exceed the caps.  The exceptions process is applicable to maintenance therapy as well as to therapy that is provided with an expectation of improvement.

Coverage for a stay in a skilled nursing facility under Medicare Part A is limited to 100 days in a benefit period for residents needing therapy services five days a week.  (Under Part A, Medicare covers room and board, nursing services, therapy services, and medications.)  [b]However, if a skilled nursing facility resident has used all 100 days in a benefit period or if the resident needs fewer than five days a week of skilled therapy services, these services can be covered by Medicare Part B.  The coverage standards for therapy under Parts A and B are the same.  However, Part B payments can continue indefinitely, if coverage standards are met.[/b][/quote]

https://medicareadvocacy.org/jimmo-v-sebelius-the-improvement-standard-case-faqs[/quote]

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