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Notes

42 C.F.R. §§ 409.21–409.26

6 sections in range

§409.21. Nursing care.

42 C.F.R. § 409.21

(a)
Basic rule. Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a registered professional nurse.
(b)
Exception. Medicare does not pay for the services of a private duty nurse or attendant. An individual is not considered to be a private duty nurse or attendant if he or she is an SNF employee at the time the services are furnished.
Notes, amendments, and revision history

Amendments

[63 FR 26306, May 12, 1998]

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

Amendments

[63 FR 26306, May 12, 1998]

§409.22. Bed and board.

42 C.F.R. § 409.22

(a)
Semiprivate and ward accommodations. Except for applicable deductible and coinsurance amounts Medicare Part A pays in full for semiprivate (2 to 4 beds), or ward (5 or more beds) accommodations.
(b)
Private accommodations—
(1)
Conditions for payment in full. Except for applicable coinsurance amounts, Medicare pays in full for a private room if—
(i)
The patient's condition requires him to be isolated;
(ii)
The SNF has no semiprivate or ward accommodations; or
(iii)
The SNF semiprivate and ward accommodations are fully occupied by other patients, were so occupied at the time the patient was admitted to the SNF for treatment of a condition that required immediate inpatient SNF care, and have been so occupied during the interval.
(2)
Period of payment. In the situations specified in paragraph (b)(1) (i) and (iii) of this section. Medicare pays for a private room until the patient's condition no longer requires isolation or until semiprivate or ward accommodations are available.
(3)
Conditions for patient's liability. The facility may charge the patient the difference between its customary charge for the private room furnished and its most prevalent charge for a semiprivate room if:
(i)
None of the conditions of paragraph (b)(1) of this section is met, and
(ii)
The private room was requested by the patient or a member of the family who, at the time of request was informed what the charge would be.
Notes, amendments, and revision history

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

§409.23. Physical therapy, occupational therapy, and speech-language pathology services.

42 C.F.R. § 409.23

Medicare pays for physical therapy, occupational therapy, or speech-language pathology services as posthospital SNF care if they are furnished—
(a)
By (or under arrangements made by) the facility and billed by (or through) the facility;
(b)
By qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, or speech-language pathologists as defined in part 484 of this chapter; and
(c)
In accordance with a plan that meets the requirements of § 409.17(b) through (d) of this part.
Notes, amendments, and revision history

Amendments

[75 FR 73613, Nov. 29, 2010]

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

Amendments

[75 FR 73613, Nov. 29, 2010]

§409.24. Medical social services.

42 C.F.R. § 409.24

Medicare pays for medical social services as posthospital SNF care, including—
(a)
Assessment of the social and emotional factors related to the beneficiary's illness, need for care, response to treatment, and adjustment to care in the facility;
(b)
Case work services to assist in resolving social or emotional problems that may have an adverse effect on the beneficiary's ability to respond to treatment; and
(c)
Assessment of the relationship of the beneficiary's medical and nursing requirements to his or her home situation, financial resources, and the community resources available upon discharge from facility care.
Notes, amendments, and revision history

Amendments

[63 FR 26306, May 12, 1998]

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

Amendments

[63 FR 26306, May 12, 1998]

§409.25. Drugs, biologicals, supplies, appliances, and equipment.

42 C.F.R. § 409.25

(a)
Drugs and biologicals. Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as posthospital SNF care only if—
(1)
They represent a cost to the facility;
(2)
They are ordinarily furnished by the facility for the care and treatment of inpatients; and
(3)
They are furnished to an inpatient for use in the facility.
(b)
Exception. Medicare pays for a limited supply of drugs for use outside the facility if it is medically necessary to facilitate the beneficiary's departure from the facility and required until he or she can obtain a continuing supply.
(c)
Supplies, appliances, and equipment. Except as specified in paragraph (d) of this section, Medicare pays for supplies, appliances, and equipment as posthospital SNF care only if they are—
(1)
Ordinarily furnished by the facility to inpatients; and
(2)
Furnished to inpatients for use in the facility.
(d)
Exception. Medicare pays for items to be used after the individual leaves the facility if—
(1)
The item is one that the beneficiary must continue to use after leaving, such as a leg brace; or
(2)
The item is necessary to permit or facilitate the beneficiary's departure from the facility and is required until he or she can obtain a continuing supply, for example, sterile dressings.
Notes, amendments, and revision history

Amendments

[63 FR 26307, May 12, 1998]

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

Amendments

[63 FR 26307, May 12, 1998]

§409.26. Transfer agreement hospital services.

42 C.F.R. § 409.26

(a)
Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15) as posthospital SNF care, if the intern or resident is in—
(1)
A participating hospital with which the SNF has in effect an agreement under § 483.70(j) of this chapter for the transfer of patients and exchange of medical records; or
(2)
A hospital that has a swing-bed approval, and is furnishing services to an SNF-level inpatient of that hospital.
(b)
Other diagnostic or therapeutic services. Medicare pays for other diagnostic or therapeutic services as posthospital SNF care if they are provided—
(1)
By a participating hospital with which the SNF has in effect a transfer agreement as described in paragraph (a)(1) of this section; or
(2)
By a hospital or a CAH that has a swing-bed approval, to its own SNF-level inpatient.
Notes, amendments, and revision history

Amendments

[63 FR 26307, May 12, 1998; 82 FR 32258, July 13, 2017]

Authority

Authority: 42 U.S.C. 1302 and 1395hh.

Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

Amendments

[63 FR 26307, May 12, 1998; 82 FR 32258, July 13, 2017]