§409.31. Level of care requirement.
42 C.F.R. § 409.31
Definition. As used in this section, skilled nursing and skilled rehabilitation services means services that:
Are ordered by a physician;
Require the skills of technical or professional personnel such as registered nurses, licensed practical (vocational) nurses, physical therapists, occupational therapists, and speech pathologists or audiologists; and
Are furnished directly by, or under the supervision of, such personnel.
Specific conditions for meeting level of care requirements.
The beneficiary must require skilled nursing or skilled rehabilitation services, or both, on a daily basis.
Those services must be furnished for a condition—
For which the beneficiary received inpatient hospital or inpatient CAH services; or
Which arose while the beneficiary was receiving care in a SNF or swing-bed hospital for a condition for which he or she received inpatient hospital or inpatient CAH services; or
For which, for an M + C enrollee described in § 409.20(c)(4), a physician has determined that a direct admission to a SNF without an inpatient hospital or inpatient CAH stay would be medically appropriate.
The daily skilled services must be ones that, as a practical matter, can only be provided in a SNF, on an inpatient basis.
Notes, amendments, and revision history
Amendments
[48 FR 12541, Mar. 25, 1983, as amended at 58 FR 30666, May 26, 1993; 68 FR 50854, Aug. 22, 2003; 70 FR 45055, Aug. 4, 2005]
Authority
Authority: 42 U.S.C. 1302 and 1395hh.
Source
Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.
Amendments
[48 FR 12541, Mar. 25, 1983, as amended at 58 FR 30666, May 26, 1993; 68 FR 50854, Aug. 22, 2003; 70 FR 45055, Aug. 4, 2005]