---
kind: "section"
citation: "42 C.F.R. § 409.31"
title: "42"
number: "409.31"
heading: "Level of care requirement."
url: "https://uscodex.org/cfr/42/409.31"
---

# §409.31. Level of care requirement.

- (a) **Definition.** As used in this section, skilled nursing and skilled rehabilitation services means services that:
  - (1) Are ordered by a physician;
  - (2) 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
  - (3) **Are furnished directly by, or under the supervision of, such personnel.**
- (b) **Specific conditions for meeting level of care requirements.**
  - (1) The beneficiary must require skilled nursing or skilled rehabilitation services, or both, on a daily basis.
  - (2) Those services must be furnished for a condition—
    - (i) For which the beneficiary received inpatient hospital or inpatient CAH services; or
    - (ii) 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
    - (iii) For which, for an M + C enrollee described in [§ 409.20(c)(4)](/cfr/42/409.20.md?p=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.
  - (3) 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

[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]