Skilled Nursing Facility Services definition

Skilled Nursing Facility Services means inpatient and related services provided by a licensed skilled nursing facility. Skilled Nursing Facility Services excludes custodial care.
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Skilled Nursing Facility Services section has been modified. Language indicating that rehabilitative therapy Services in a Skilled Nursing Facility are subject to the “Rehabilitative Therapy Services” limits has been removed for accuracy.  The “Exclusions and Limitations” section has been modified. The Infertility Services exclusion has been removed from all EOCs in which there is an “Infertility Services” section, as covered and excluded infertility Services are described within that section. In EOCs without an “Infertility Services” section, the exclusion has been aligned across products for consistency with the exclusions as stated in EOCs with an “Infertility Services” section. The exclusion language and administration has not changed.  Language in the “Covered Drugs and Supplies” section has been added to clarify that over-the-counter contraceptive drugs, devices, and products approved by the FDA, do not require a prescription in order to be covered per Senate Bill 6219. Administrative changes or clarifications  The First Choice Health Network name has been updated to align with the Healthcare Consumer Access Unit filing. “PPO” and “(FCH PPO)” have been removed from the name.  The introduction paragraph of the Benefit Summary has been modified. A sentence has been added referring readers to the “Definitions” section of their EOC for a list of defined terms.  The “Adding New Dependents to an Existing Account” section of the EOC has been modified. Language has been reintroduced to clarify that an enrollment application is required to add new dependents if additional premium is required to add the dependent and that the application requirement is waived if additional premium is not required.  The “Prior and Concurrent Authorization and Utilization Review” and “Self-referred Spinal and Extremity Manipulation Therapy Services” sections of the Traditional, Deductible and High Deductible Health Plan EOCs have been modified to explain that prior authorization determinations shall expire no sooner than 45 days from the date of approval.  All references to the “Chiropractic Services Rider” have been removed as these Services are now included on the “Alternative Care Services Rider” when purchased by a group.  The URL for the HRSA women’s preventive care Services has been updated for accuracy.  All references to the Mail-Delivery Pharmacy in the EOC and Benefit Summary have been modified to Mail-Order Pharmacy for alignment with Pharmacy Department terminology and marketing collateral m...
Sample 1
Skilled Nursing Facility Services section has been modified. Language indicating that rehabilitative therapy Services in a Skilled Nursing Facility are subject to the “Rehabilitative Therapy Services” limits has been removed for accuracy.  The “Exclusions and Limitations” section has been modified. The Infertility Services exclusion has been removed from all EOCs in which there is an “Infertility Services” section, as covered and excluded infertility Services are described within that section. In EOCs without an “Infertility Services” section, the exclusion has been aligned across products for consistency with the exclusions as stated in EOCs with an “Infertility Services” section. The exclusion language and administration has not changed.  The “Internally implanted devices” bullet in the “Benefits for Outpatient Services” and “Benefits for Inpatient Hospital Services” sections of the EOC have been modified to clarify that “bilateral” cochlear implants and bone-anchored hearing aids are covered, to better align with Oregon House Bill 4104.  Language has been added to the “Post-Stabilization Care” section of the EOC due to ORS 743B.287 prohibiting balance billing by Non-Participating Providers at Participating Facilities.
Sample 1

Examples of Skilled Nursing Facility Services in a sentence

  • Skilled Nursing Facility Services Subject to all of the inpatient hospital services provisions under Section A., medically necessary skilled nursing services, including subacute care, will be covered when provided in a skilled nurs- ing facility and authorized.

  • To see the benefit level for inpatient hospital or skilled nursing facility services, see benefits under Inpatient Hospital and Skilled Nursing Facility Services.

  • Except as stated below, the following Services are covered when hospitalized by a [Network] Provider upon prior Referral from a [Member's] Primary Care Provider, only at [Network] Hospitals and [Network] Facilities (or at [Non-Network]Facilities subject to Our Pre-Approval); however, [Network] Skilled Nursing Facility Services and Supplies are limited to those which constitute Skilled Nursing Care and Hospice services are subject to Our Pre-Approval.

  • You or your Physician must obtain the Claims Administrator approval at least 5 working days before Hospital or Skilled Nursing Facility admissions for all non-Emergency Inpatient Hospital or Skilled Nursing Facility Services.

  • Skilled Nursing Facility Services Skilled Nursing Facility services are covered for up to a maximum of 100 days per benefit period in a semi-private room (unless a private room is Medically Necessary).

  • Hospital Benefits (Facility Services) Other than Mental Health Services, Hospice Program Ser- vices, Skilled Nursing Facility Services, Dialysis Benefits, and Bariatric Surgery Services for residents of designated counties which are described in other sections.

  • Benefits for Skilled Nursing Facility Services cannot exceed the Maximum number of days shown in SECTION SB - SCHEDULE OF BENEFITS of this Agreement.

  • Skilled Nursing Facility Services – Services in a Skilled Nursing Facility.

  • Skilled Nursing Facility Services Subject to all of the inpatient hospital services provisions under Section A., medically necessary skilled nursing services, including subacute care, will be covered when provided in a skilled nurs-ing facility and authorized.

  • Skilled Nursing Facility Services require Prior Approval from the Company.

Related to Skilled Nursing Facility Services

  • Skilled Nursing Facility means an institution or part thereof that is licensed as a Skilled Nursing Facility by the State of Florida, and is accredited as a Skilled Nursing Facility by The Joint Commission or recognized as a Skilled Nursing Facility by the Secretary of Health and Human Services of the United States under Medicare.

  • Nursing facility means an institution as defined in Iowa Code chapter 135C. This definition does not include acute care settings.

  • Nursing services means the provision of individual-specific advice, plans, or interventions by a nurse at a home based on the nursing process as outlined by the Oregon State Board of Nursing. Nursing services differ from administrative nursing services.

  • Skilled Nursing Care means services requiring the skill, training or supervision of licensed nursing personnel.

  • Non-Administrator Skilled Nursing Facility means a Skilled Nursing Facility which does not have an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan but has been certified in accordance with guidelines established by Medicare.

  • Nursing Service Plan means the plan that is developed by the registered nurse based on an Individual’s initial nursing assessment, reassessment, or updates made to a nursing assessment as a result of monitoring visits. The Nursing Service Plan must describe all licensed nursing services the Individual shall receive and be pursuant to the Individual’s Service Plan.

  • Nursing program means a series of courses leading to an LPN certificate or an ADN degree provided through a Wyoming community college; or a BSN degree or a Master’s degree provided through the University of Wyoming; or, in the case of a candidate for a doctoral degree, provided through an institution offering the required nursing education courses under contract with the WICHE, or in a distance nursing education program provided through a university that is regionally accredited.

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • Utility Services means physical plant including but not limited to pipes, valves, conduits, cables, terminals, transformers, etc. owned and operated by communications, television, hydro, gas and oil companies or any other utility companies.

  • Tanning facility means a place that provides access to tanning devices for compensation.

  • Nursing care means the practice of nursing by a licensed nurse, including tasks and functions relating to the provision of "nursing care" that are taught or delegated under specified conditions by a registered nurse to a person other than licensed nursing personnel, as governed by ORS chapter 678 and rules adopted by the Oregon State Board of Nursing in OAR chapter 851.

  • Standard fertility preservation services means procedure based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society for Clinical Oncology, or other national medical associations that follow current evidence-based standards of care.

  • Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Educational facility means a structure available for use as a dormitory or other housing facility, including housing facilities for students, a dining hall, student union, administration building, academic building, library, laboratory, research facility, classroom, athletic facility, health care facility, and maintenance, storage, or utility facility, and other structures or facilities related thereto or required or useful for the instruction of students or the conducting of research or the operation of an institution for higher education, including parking and other facilities or structures essential or convenient for the orderly conduct of the institution for higher education, and shall include lands and interests in lands and landscaping, site preparation, furniture, equipment, machinery, and other similar items necessary or convenient for the operation of a particular facility or structure in the manner for which its use is intended, and any improvements necessary to a particular facility to make the facility more energy efficient. Educational facility does not include items as books, fuel, supplies, or other items the costs of which are customarily deemed to result in a current operating charge and does not include any facility used or to be used for sectarian instruction or as a place of religious worship, nor a facility which is used or to be used primarily in connection with a part of the program of a school or department of divinity for a religious denomination.

  • Marijuana testing facility means an entity licensed to analyze and certify the safety and potency of marijuana.

  • Intermodal Rail Yard means a rail facility in which cargo is transferred from drayage truck to train or vice-versa.

  • Nursing Care Plan means a plan of care developed by a nurse that describes the medical, nursing, psychosocial, and other needs of a child and how those needs shall be met. The Nursing Care Plan includes which tasks shall be taught, assigned, or delegated to the qualified provider or family.

  • Psychiatric facility means a psychiatric hospital or psychiatric unit licensed under section 134.

  • Rehabilitation services means face-to-face individual or group services provided by qualified staff to develop skill necessary to perform activities of daily living and successful integration into community life.

  • Cannabis processing facility means a person that:

  • Professional sports services contract means an agreement under which an individual is employed as a professional athlete or agrees to render services as a player on a professional sports team or with a professional sports organization.

  • Stormwater management planning area means the geographic area for which a stormwater management planning agency is authorized to prepare stormwater management plans, or a specific portion of that area identified in a stormwater management plan prepared by that agency.

  • Vocational rehabilitation services means professional services reasonably necessary during or after, or both during and after, medical treatment to enable a disabled injured employee to return to gainful employment as soon as practical. "Vocational rehabilitation services" includes vocational evaluation, retraining and job placement.

  • Multiphase professional services contract means a contract for the providing of professional

  • Moving beam radiation therapy means radiation therapy with any planned displacement of radiation field or patient relative to each other, or with any planned change of absorbed dose distribution. It includes arc, skip, conformal, intensity modulation and rotational therapy.

  • Long-term inpatient care means inpatient services for