409.31—Level of care requirement.
(a) Definition.
As used in this section, skilled nursing and skilled rehabilitation services means services that:
(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
(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.
(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), 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.
[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]