When You
Hear "We’re Stopping Therapy" — Dig Deeper!
Medicare will pay costs of "skilled rehabilitation services"
received in a nursing home. This includes services that require
the skills of physical therapists, occupational therapists
or speech pathologists (together in this article, "therapy").
Payment for therapy is subject to Medicare’s limits on numbers
of days covered in a nursing home setting. For the first 20
days Medicare pays 100%; for days 21 to 100 Medicare pays
the amount due after a $95.50 per day deductible.
From time to time we hear that a nursing home has stopped
or is about to stop providing therapy to a resident — giving
the reason that Medicare will not pay the costs of therapy
if the resident is "not improving." Another way
this reason is given is by saying that the resident has reached
a "plateau."
When a nursing home gives this reason, it is wrong!
Legally, "lack of improvement" is not a reason
for stopping therapy.
