Current through Register Vol. 54, No. 12, March 23, 2024
(a) Skilled nursing care is a covered home
health service and is reimbursable under the MA Program if the following
conditions are met:
(1) The services are
ordered by and included in the plan of treatment established by the recipient's
attending physician.
(2) The
services are performed by a registered nurse or a licensed practical nurse. A
home health agency is not reimbursed for personal care services performed by a
registered nurse or licensed practical nurse if not provided in conjunction
with skilled services.
(3) The
services are reasonable and necessary to the treatment of an illness or injury.
To be considered reasonable and necessary, the services furnished shall be:
(i) Consistent with the recipient's
particular medical needs as determined by the recipient's attending
physician.
(ii) Consistent with
accepted standards of medical practice.
(b) Skilled nursing care includes, but is not
limited to, the following:
(1) Observation and
evaluation.
(2) Teaching and
training the recipient or family members to provide care such as, but not
limited to:
(i) Giving an injection.
(ii) Irrigating a catheter.
(iii) Applying dressings to wounds involving
prescription medications and aseptic techniques.
(iv) Teaching the proper use of
medications.
(3)
Insertion and sterile irrigation of catheters.
(4) Bladder training.
(5) Administering injections.
(6) Administering enteral and intravenous
total parenteral nutrition.
(7)
Treating decubitus ulcers and other skin disorders.
(c) Activities, such as the administration of
eye drops, topical ointments, bathing the skin and applying creams do not
constitute skilled care.
The provisions of this §
1249.53 amended under sections
403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S.
§§
403(a) and (b),
443.2(2) and
509).
This section cited in 55 Pa. Code §
1249.51 (relating to general
payment policy).
