What Are the Medicare Coverage Qualifications for Skilled Therapy Services in an Inpatient Rehabilitation Hospital?

Rehabilitation hospitals are specialty hospitals or parts of acute care hospitals that offer intensive inpatient rehabilitation therapy. You may need inpatient care in a rehabilitation hospital if you are recovering from a serious illness, surgery, or injury and require a high level of specialized care that generally cannot be provided in another setting (such as in your home or a skilled nursing facility). Examples of common conditions that may qualify you for care in a rehabilitation hospital include stroke, spinal cord injury, and brain injury. You may not qualify for care if, as an example, you are recovering from hip or knee replacement and have no other complicating condition. Medicare-covered services offered by rehabilitation hospitals include:

  • Medical care and rehabilitation nursing
  • Physical and occupational therapy and speech/language pathology
  • Social worker assistance
  • Psychological services
  • Orthotic and prosthetic services

To qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is medically necessary, meaning you must require all of the following services to ensure safe and effective treatment:

  • 24-hour access to a doctor (meaning you require frequent, direct doctor involvement, at least every 2-3 days)
  • 24-hour access to a registered nurse with specialized training or experience in rehabilitation
  • Intensive therapy, which generally means at least three hours of therapy per day (but exceptions can be made on a case by case basis—you may still qualify if you are not healthy enough to withstand three hours of therapy per day)
  • And, a coordinated team of providers including, at minimum, a doctor, a rehabilitation nurse, and one therapist

Your doctor must also expect that your condition will improve enough to allow you to function more independently after a rehabilitation hospital stay. For example, therapy may help you regain the ability to eat, bathe, and dress on your own, live at home, and/or live with family rather than in a living facility. If you qualify for Medicare-covered care in a rehabilitation hospital, your out-of-pocket costs will be the same as for any other inpatient hospital stay. You will have a $1,408 deductible each benefit period, no coinsurance for days 1-60 as an inpatient, a $352 daily coinsurance for days 61-90, and a $704 daily coinsurance for 60 lifetime reserve days.

Keep in mind that if you enter a rehabilitation hospital after being an inpatient at a different facility, you will still be in the same benefit period. If you do not qualify for a Medicare-covered stay in an inpatient rehabilitation hospital, you may qualify for rehabilitation care from a skilled nursing facility, a home health agency, or an outpatient setting.

Read More: What Are the Medicare Coverage Qualifications for Skilled Therapy Services in a Skilled Nursing Facility (SNF)?
Learn About: Am I Eligible for Medicare Coverage of Skilled Therapy Services as Part of Home Health Care?
Return to: Medicare In-Depth

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