Skilled Nursing Facility. A Facility which mainly provides full-time Skilled Nursing Care for Ill or Injured people who do not need to be in a Hospital. It must carry out its stated purpose under all relevant state and local laws, and it must either:
Skilled Nursing Facility. An institution or a distinct part of an institution that is licensed or approved under state or local law, and which is primarily engaged in providing skilled nursing care and related services as a Skilled Nursing Facility, extended care facility, or nursing care facility approved by the Joint Commission on Accreditation of Health Care Organizations or the Bureau of Hospitals of the American Osteopathic Association, or as otherwise determined by HMO to meet the reasonable standards applied by any of the aforesaid authorities. • Specialist(s). A Physician who provides medical care in any generally accepted medical or surgical specialty or subspecialty.
Skilled Nursing Facility. An institution or a distinct part of an institution that is licensed or approved under state or local law, and which is primarily engaged in providing Skilled Nursing care and related services for residents who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Skilled Nursing Facility does not include institutions which provide only minimal care, Custodial Care services, ambulatory or part-time care services, or institutions which primarily provide for the care and treatment of mental illness and substance abuse. The facility must qualify as a Skilled Nursing Facility under Medicare or as an institution accredited by the Joint Commission on Accreditation of Health Care Organizations, the Bureau of Hospitals of the American Osteopathic Association, the Commission on the Accreditation of Rehabilitative Facilities, or as otherwise determined by the health insurer to meet the reasonable standards applied by any of the aforesaid authorities. Examples of Skilled Nursing Facilities include Rehabilitation Hospitals (all levels of care, e.g. acute) and portions of a Hospital designated for Skilled or Rehabilitation services. The Home Health Benefits provision under the Covered Benefits section of the Certificate is hereby deleted and replaced with the following:
Skilled Nursing Facility. A Facility which mainly provides full-time Skilled Nursing Care for Ill or Injured people who do not need to be in a Hospital. It must carry out its stated purpose under all relevant state and local laws, and it must either: be accredited for its stated purpose by The Joint Commission; or be approved for its stated purpose by Medicare. SMALL EMPLOYER. Means in connection with a Group Health Plan with respect to a Calendar Year and a Plan year, an employer who employed an average of at least 1 but not more than 50 Employees on business days during the preceding Calendar Year and who employs at least 1 Employee on the first day of the Plan Year. All persons treated as a single employer under subsection (b), (c), (m) or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as one employer. In the case of an Employer which was not in existence throughout the preceding Calendar Year, the determination of whether such employer is a small or large employer shall be based on the average number of Employees that it is reasonably expected such Employer will employ on business days in the current Calendar Year. The following calculation must be used to determine if an employer employs at least 1 but not more than 50 Employees. For purposes of this calculation:
Skilled Nursing Facility. An institution (or a distinct part of an institution) that meets the criteria as set forth in
Skilled Nursing Facility. Shall be defined as a specially qualified and licensed facility that:
2.1.77.1 For a fee and on an Inpatient basis, provides 24 hour per day skilled Nursing services under the full-time supervision of a Physician or Nurse and provides physical restoration services for persons convalescing from an Injury or Illness; and
2.1.77.2 maintains daily clinical records; and
2.1.77.3 complies with legal requirements applicable to the operation of a skilled nursing institution; and
2.1.77.4 has transfer arrangements with one or more Hospitals; and
2.1.77.5 has an effective utilization review plan; and
2.1.77.6 is approved and licensed by the jurisdiction in which it operates.
Skilled Nursing Facility a Facility Provider approved by the state, certified by Medicare which, for compensation from its patients, is primarily engaged in providing Skilled Nursing Services on an Inpatient basis to patients requiring twenty-four (24)-hour Skilled Nursing Services but not requiring confinement in an acute care general hospital. Such care is rendered by or under the supervision of Physicians. A Skilled Nursing Facility is not, other than incidentally, a place that provides:
a. minimal care, Custodial Care, ambulatory care, or part-time care services, or b. care or treatment of Mental Illness, Substance Abuse or pulmonary tuberculosis. 131. SKILLED NURSING SERVICES/SKILLED REHABILITATION SERVICES - Services which have been ordered by and under the direction of a Physician or Member’s PCP, and are provided either directly by or under the supervision of a medical professional: e.g., Registered Nurse, Physical Therapist, Licensed Practical Nurse, Occupational Therapist, Speech Pathologist, or Audiologist with the treatment described and documented in the patient’s medical records. Unless otherwise determined in the sole discretion of the Plan, Skilled Nursing Services/Skilled Rehabilitation Services shall be subject to the following: a. the Skilled Nursing Services/Skilled Rehabilitation Services must be of a level of complexity and sophistication, or the condition of the patient must be of a nature that requires the judgment, knowledge, and skills of a qualified licensed medical professional and must be such that the care could not be performed by a non-medical individual instructed to deliver such Services.
b. the Skilled Rehabilitation Services must be provided with the expectation that the patient has restorative potential and that the condition will improve materially in a reasonable and generally predictable period of time. Once a maintenance level has been established or no further progress is attained, the Services are no longer classified as Skilled Rehabilitation and will be classified as Custodial Care. The mere fact that a Physician has ordered or prescribed a therapeutic regimen does not, in itself, determine whether a Service is a Skilled Nursing Service or a Skilled Rehabilitation Service. 132. SKILLED REHABILITATION SERVICES - the combined use of medical, social, educational, and vocational services to enable patients disabled by disease or injury to achieve the highest possible level of functional ability. Skilled Rehabilitation Services are provided ...
Skilled Nursing Facility. An institution operated alone or with a Hospital which gives care after a Member leaves the Hospital for a condition requiring more care than can be rendered at home. It must be licensed by the appropriate state agency and accredited by the Joint Commission on Accreditation of Health Care Organizations, or otherwise determined by Us to meet the reasonable standards applied by any of the aforesaid authorities. High-cost, injectable, infused, oral or inhaled medications that typically require close supervision and monitoring of their effect on the patient by a medical professional. Specialty Drugs often require special handling such as temperature-controlled packaging and overnight delivery and are often unavailable at retail pharmacies. Most Specialty Drugs require Prior Authorization.
Skilled Nursing Facility a facility with a valid license issued by the California Department of Public Health as a Skilled Nursing Facility or any similar institution licensed under the laws of any other state, territory, or foreign country. Also included in a Skilled Nursing unit within a Hospital.
Skilled Nursing Facility. (SNF) — As defined in California Code of Regulations, Title 22 section 51121(a), any institution, place, building, or agency which is licensed as a SNF by the California Department of Public Health (CDPH) or is a distinct part or unit of a hospital, meets the standard specified in section 51215 of these regulations (except that the distinct part of a hospital does not need to be licensed as a SNF) and has been certified by DHCS for participation as a SNF in the Medi-Cal program. Section 51121(b) further defines the term "Skilled Nursing Facility" as including terms "skilled nursing home", "convalescent hospital", "nursing home", or "nursing facility".
