Skilled Nurse Visit (SNV) Services

Revised: June 16, 2026

· Overview

· Eligible Providers

· Eligible Members

· Authorization Requirements

· Assessment Requirements

· Covered Services

· Noncovered Services

· Billing

· Legal References

Overview

Skilled nursing visits are intermittent nursing services ordered by a physician, advanced practice registered nurse (APRN), or physician assistant (PA) for a member whose illness, injury, physical, or mental condition creates a need for the service. Services under the direction of a registered nurse (RN) are provided in the member’s residence by an RN or a licensed practical nurse (LPN) and provided under a plan of care or service plan that specifies a level of care that the nurse is qualified to provide.

Eligible Providers

Medicare-certified home health agencies with a comprehensive home care license.

Eligible Members

Member must be eligible under one of the following programs:

AC	Alternative Care Program
BB	MinnesotaCare - state and federally funded coverage for adults age 19 years and older.
EH	Emergency Medical Assistance with an approved care plan certification.
KK	MinnesotaCare - state funded coverage for children through the end of the month they turn 19 years old.
LL	MinnesotaCare - state and federally funded coverage for children through the month they turn 19 years old.
MA	Medical Assistance
NM	State-funded Medical Assistance (MA)
RM	Refugee Medical Assistance (MA)
	Waiver Services Programs

Authorization Requirements

The following services must be authorized before being delivered:

· Skilled nurse services above nine visits per member, per calendar year (MA home care)

· All telehomecare

· Waiver services (the case manager must authorize)

The authorization cannot begin before the date the Minnesota Department of Human Services receives the complete authorization request with all required documentation. In addition, each person is limited to two SNVs per day if applicable.

Assessment Requirements

SNVs must be ordered by a physician, an APRN, or a PA and must be medically necessary. All SNVs, other than SNV provided as a one-time perinatal, must comply with the face-to-face visit requirement.

An RN or appropriate therapist from an enrolled Medicare-certified home health agency completes an assessment to document the person’s need for service and keeps it in the person’s record.

This assessment includes the following:

1. Identifies the person’s needs

2. Has an individualized care or service plan

3. Requests authorization for the number of:

· LPN SNV units required to meet the person’s needs.

· RN SNV units required to meet the person’s needs.

Covered Services

· Services provided according to the member’s written plan of care or service plan.

· Intermittent home visits to initiate and complete professional nursing tasks based on a member’s need for service as assessed to maintain or restore optimal health. Visits are made by a RN or LPN, employed by a Medicare-certified home health agency, under the supervision of an RN. If the necessary medical services are more complex and require more time than can be performed in a single or twice-daily skilled nurse visit, home care nursing (HCN) services is an appropriate option.

· Observation, assessment, and evaluation of a person’s physical or mental health status. This may be covered when the likelihood of a change in condition requires skilled nursing personnel to identify and evaluate the need for possible modification of treatment or initiation of additional medical procedures until the member’s treatment regimen is stabilized.

· A procedure that requires substantial and specialized nursing skill, such as administration of intravenous therapy, intramuscular injections, or procedures such as sterile catheter insertion or sterile wound cares.

· Teaching and training that requires the skills of a nurse. Examples include, teaching self-administration of injectable medications or a complex range of medications; teaching a newly diagnosed diabetic person or caregiver on all aspects of diabetic management; teaching self-catheterization or bowel or bladder training.

· Postpartum visits to new mothers and their newborn infants if the mother and her newborn are discharged early from the hospital. Early discharge means less than 48 hours following a vaginal delivery or less than 96 hours following a Cesarean section. Postdelivery care includes a minimum of one home visit by a licensed RN. The RN must provide parent education, assistance and training in breast and bottle feeding and conduct any necessary and appropriate clinical tests. The licensed RN must make the home visit within four days following hospital discharge. A separate plan of care is needed for the mother and newborn.

· Community health nursing visits provided by a public health agency or home health agency for the sole purpose of maternal, child, and adult health promotion only when an authorized skilled nursing service is provided at the same visit.

· Telehomecare visits. Coverage of telehomecare is limited to two visits per day and all of the visits must be prior authorized.

· Skilled nurse visits for fewer than 90 days for a recipient residing in an ICF/DD to prevent admission to a hospital or nursing facility, if the ICF/DD is not required to provide the nursing services. The home health agency must obtain prior authorization.

· Venipuncture from a peripheral site. The home health provider can submit a request for prior authorization if they have determined and documented:

· That no lab service is available that can visit the recipient’s home to obtain the venipuncture from the peripheral site

· That no service is reasonably available to the recipient outside of his or her place of residence

· The recipient no longer qualifies for Medicare Part A skilled nurse services

Noncovered Services

· Usual and customary equipment and supplies that are necessary to complete a SNV (such as stethoscope, nail clippers, sphygmomanometer, alcohol wipes and so on)

· SNV for the sole purpose of supervising a home health aide or personal care worker. However, supervision may be done during a SNV that qualified for payment

· SNV for the sole purpose of monitoring medication compliance with an established medication program for a member

· SNV for the sole purpose of monitoring a member’s overall physical status, when the member’s physical status has not changed and the person is considered stable

· SNV to set up or administer oral medications; pre-fill injections, such as insulin syringes for an adult member when the need can be met by an available pharmacy; when the member is physically and mentally able to self-administer or pre-fill a medication; or if the activity can be delegated to a family member

· When the sole purpose of the visit is to train other home health agency workers

· When the visit is performed in a place other than the member’s residence

· For Medicare evaluation or administrative nursing visits required by Medicare but not qualifying as a SNV. (These visits are an administrative expense for the Medicare-certified agency and cannot be billed to MA.)

· SNV provided by an RN that is employed by a personal care provider organization (PCPO) or community first services and supports (CFSS) provider, or a non-Medicare certified home care nursing agency

· A communication between the home care nurse and recipient that consists solely of a telephone conversation, facsimile, electronic mail or a consultation between two health care practitioners is not considered a telehomecare visit

· Services provided in a state where the nurse is not licensed

Billing

MA members that are not on a waiver are eligible for nine skilled nurse visits per calendar year without authorization. All waiver recipients must have a valid service authorization including SNV.

All provider types must follow general MHCP billing policies and guidelines in the Billing Policy Overview section under Provider Basics in the MHCP Provider Manual when submitting claims to MHCP.

Submit claims for reimbursement of Home Care (Non-PCA) Services using the (837I) Institutional transaction.

Legal References

Code of Federal Regulations, title 42, section 484.30 (Condition of participation: Skilled nursing services)
Minnesota Statutes, 256B.0625, subdivision 2 (Covered services Skilled and Intermediate Nursing Care)
Minnesota Statutes, 256B.0651 (Home Care Services)
Minnesota Statutes, 256B.0653 (Home Health Agency Services)
Nurse Practice Act on the Minnesota Board of Nursing webpage