Common use of Skilled Nursing Facility Clause in Contracts

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 by or under the supervision of an organized staff of Physicians. Continuous nursing services are provided under the supervision of a Registered Nurse.

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, 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 by or under the supervision of an organized staff of Physicians. Continuous nursing services are provided under the supervision of a Registered Nurse.