Current through Register Vol. 54, No. 24, June 15, 2024
Section 1249.53 - Payment conditions for skilled nursing care(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:(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.(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 adopted December 6, 1980, effective 12/1/1980, 10 Pa.B. 4618; amended August 12, 1988, effective 9/1/1988, 18 Pa.B. 3571.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).