Your dad has Parkinson's, and his therapist just said Medicare won't keep paying because he isn't improving anymore. Before you accept that, know this: Medicare does not require you to be improving to cover therapy or skilled nursing. Care that just holds your ground counts too.

In This Guide

Does Medicare Require Improvement to Cover Therapy?

No. And this is one of the most expensive myths in all of Medicare, because it gets people to walk away from care they're actually entitled to.

The idea has a name: the "Improvement Standard." It's the assumption, repeated by some therapists, discharge planners, and billing offices, that Medicare only pays for skilled care while you're getting measurably better, and cuts you off the moment you plateau. According to the Centers for Medicare & Medicaid Services (CMS), that rule of thumb is a myth the Medicare statute and regulations have never actually supported.

What settled the question was a class-action lawsuit. Under the Jimmo v. Sebelius settlement, approved by a federal court in January 2013, CMS confirmed that coverage of skilled nursing and skilled therapy turns on your need for skilled care, not on your potential to improve. Skilled care is covered when it's needed to maintain your current condition or to prevent or slow further decline. A lack of restoration potential can't, on its own, be the basis for a denial.

The regulation says the same thing in plainer words. Under 42 CFR 409.32, "the restoration potential of a patient is not the deciding factor," and even when full recovery isn't possible, a patient may need skilled services to prevent deterioration or preserve current abilities. So if you've been told Medicare stops paying once you stop improving, the rulebook is on your side.

Which Medicare Benefits Require No Improvement to Cover Therapy

The maintenance standard isn't limited to one corner of Medicare. It applies across three skilled benefits: care in a skilled nursing facility, home health, and outpatient therapy.

That matters most for people with chronic or progressive conditions, where "getting better" was never the realistic goal. Think of someone living with multiple sclerosis, Parkinson's, or ALS, or someone whose recovery after a stroke has leveled off. For them, skilled physical, occupational, or speech therapy might be exactly what keeps them walking, swallowing, or transferring safely, even if the underlying condition won't reverse. The same goes for skilled nursing that keeps a wound from worsening or a chronic condition from spiraling.

Under the improvement myth, all of that care looks deniable, because the person isn't on an upward curve. Under the actual rule, holding steady is a covered goal. If skilled hands are needed to maintain the person or slow the slide, Medicare's coverage standard is met.

What Still Has to Be True for Medicare to Pay

Maintenance coverage is not a blank check, and it helps to be honest about that going in. The Jimmo settlement removed the improvement requirement. It didn't remove everything else.

The care still has to be skilled, meaning it genuinely requires a licensed professional, and it still has to be reasonable and necessary for your condition. A maintenance therapy program has to be safe and effective enough that it takes a skilled therapist to carry out or design, not something an aide or family member could do just as well.

The benefit-specific rules also stand. For a skilled nursing facility stay, you generally still need a qualifying prior inpatient hospital stay of at least three days, and time spent under observation or in the emergency room before you're admitted doesn't count toward it. Some Medicare Advantage plans, and doctors in an ACO with a skilled nursing facility 3-day rule waiver, waive that requirement. For home health, you still have to meet the homebound test.

And the normal costs apply. Outpatient therapy is a Part B service, so you pay the annual Part B deductible ($283 in 2026) and then 20% of the Medicare-approved amount. In a skilled nursing facility, days 1 through 20 are covered in full after that qualifying hospital stay, then days 21 through 100 carry a coinsurance of $217 a day in 2026. Maintenance care follows the same cost rules as any other skilled care; it just can't be denied for lack of improvement.

How to Push Back on an Improvement-Standard Denial

So a therapist or facility tells you Medicare won't cover more because your parent has "plateaued" or has "no improvement potential." What do you do?

First, name the standard out loud. Ask whether the decision is based on lack of improvement, and point out that under the Jimmo settlement, that isn't a valid reason on its own. Sometimes just knowing the provider understands the rule keeps the care going. Documentation helps here: the therapist's notes should describe why skilled care is needed to maintain function or prevent decline, not frame everything around progress toward recovery.

If the care has already been denied on a Medicare claim, you have the right to appeal, and an improvement-standard denial is a strong case to bring. Our guide on how to appeal a Medicare denial walks through the levels and deadlines step by step. Two other resources worth knowing: the Center for Medicare Advocacy, a nonprofit that publishes self-help materials on exactly this issue, and the Medicare Beneficiary Ombudsman can help when you're stuck.

The short version? Don't take "you're not improving" as the final word. It isn't the rule, and it hasn't been for a long time.

Frequently Asked Questions

If my condition is chronic and won't improve, can I still get skilled therapy?

Yes, as long as the therapy genuinely needs a licensed professional and is reasonable and necessary for your condition. Medicare covers skilled therapy that maintains your function or slows decline, not only therapy that's expected to make you better. A progressive diagnosis like Parkinson's or MS doesn't disqualify you.

What is the Jimmo v. Sebelius settlement?

It's a class-action settlement approved by a federal court in January 2013 in which CMS confirmed that Medicare coverage of skilled nursing and skilled therapy depends on your need for skilled care, not on whether you're likely to improve. It didn't create a new benefit; it clarified that the "Improvement Standard" was never the actual rule.

Does maintenance coverage mean Medicare pays indefinitely?

No. The improvement requirement is gone, but every other rule stays. The care still has to be skilled and reasonable and necessary, and the skilled nursing facility and home health rules still apply. Once genuinely skilled care is no longer needed, coverage can end, even if it wasn't ended for lack of improvement.

What should I do if a provider says I have "no improvement potential"?

Ask whether the denial rests on lack of improvement, and note that the Jimmo settlement makes that an invalid reason by itself. Make sure the clinical notes explain why skilled care is needed to maintain or protect your function. If Medicare has already denied a claim, file an appeal.

Learn More

MedicareHow Medicare Covers Physical, Occupational, and Speech TherapyMedicare therapy coverage in 2026: the $283 Part B deductible, 20% coinsurance, the $2,480 KX modifier threshold, and how to keep claims paying above it. MedicareWhat Medicare Covers for Skilled Nursing, Home Health, and HospiceDoes Medicare cover skilled nursing, home health, and hospice? A 2026 guide to what's paid, for how long, the costs, and the long-term care gap to watch for. MedicareWho Qualifies for Medicare Home Health CareMedicare covers home health care when you meet four rules, and the homebound test surprises most families. Here is who qualifies and what it costs in 2026. MedicareHow to Appeal a Medicare DenialA Medicare denial isn't final. Here's how to appeal one through all five levels, with 2026 deadlines, dollar thresholds, and the fast track for urgent care.

Find personalized help fighting a Medicare therapy or skilled-nursing denial at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.