"To qualify, CMS states that only post-hospital admissions to nursing facilities are covered and the hospital stay must be at least three days. Beyond that, a physician must verify that the resident requires skilled nursing and the services must be provided at least six days a week by a skilled restorative nursing professional (a registered nurse is not considered a skilled professional in this area)."
That information was not attributed to me, and it did not come from me - but I agree with you that the parenthetical _expression_ at the end of it is an error.
Restorative services are nursing services, and the programs must be supervised by the nursing department. Restorative services may be carried out by nursing personnel or by the therapy department (as long as the therapy department is not supervising the program and as long as the therapy time is captured in P3 and NOT in P1b). Though restorative programs generally are carried out by nursing assistants trained in restorative care, a registered nurse certainly is qualified to carry out the program.
The requirements outlined in the instructions for section P3 of the MDS must be met in order for the services to qualify as skilled restorative programs. In addition, the programs must be part of active treatment, e.g., the institution and supervision of bowel
and bladder training programs and must be delivered at least 6 days per week.
This is from Medicare Benefit Policy Manual
Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance
<<QUOTE
30.6 - Daily Skilled Services Defined
(Rev. 1, 10-01-03)
A3-3132.5, SNF-214.5
Skilled nursing services or skilled rehabilitation services (or a combination of these services) must be needed and provided on a "daily basis," i.e., on essentially a seven days a week basis. A patient whose inpatient stay is based solely on the need for skilled rehabilitation services would meet the "daily basis" requirement when they need and receive those services on at least five days a week. (If therapy services are provided less than five days a week, though, the "daily" requirement would not be met.)
This requirement should not be applied so strictly that it would not be met merely because there is an isolated break of a day or two during which no skilled rehabilitation services are furnished and discharge from the facility would not be practical.
EXAMPLE
A patient who normally requires skilled rehabilitation services on a daily basis may exhibit extreme fatigue, which results in suspending therapy sessions for a day or two. Coverage may continue for these days since discharge in such a case would not be practical.
In instances when a patient requires a skilled restorative nursing program to positively impact his functional well-being, the expectation is that the program be rendered at least six days a week. (Note that when a patient's skilled status is based on a restorative program, medical evidence must exist to justify the services. In most instances, it is expected that duration of a skilled restorative program last only a couple of weeks.).
>>END QUOTE
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Question for Rena
Date: 3/14/04 7:56:10 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Rena, in the McKnight interveiw on Overlooked charges you stated that new CMS clarification requires that a skilled restorative professional (not an RN) is required. Where can I find the reference for this? Thanks.
Denise F. O'Donnell, RN, RAC-C, MN, NHA
