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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Skilled nursing visit

Page posted: 10/1/03

Page reviewed:

Page updated: 8/4/11

Legal Authority

42 C.F.R. part 484, Minn. Stat. §256B.0625, subd. 6a, Minn. Stat. §256B.0651 and Minn. Stat. §256B.0653

Definition

Skilled nursing visit (SNV): Visit to a person’s place of residence, on an intermittent basis, by a registered nurse or licensed practical nurse under the supervision of a RN, to initiate and complete professional nursing tasks based on the assessed need for services to maintain or restore optimal health.

Place of residence

The following are considered a place of residence:

  • • Home rented, owned or shared
  • • Rule 5 residential program for children with severe emotional disturbances
  • • Rule 8 group home
  • • Rule 35 chemical dependency rehabilitation program
  • • Rule 36 residential facility for adults with mental illness
  • • Residential program and service for persons with developmental disabilities, excluding Intermediate Care Facilities for Persons with Developmental Disabilities (IFCs/DD)
  • • Non-certified boarding care home eligible for group residential housing room and board payment.
  • ICF/DD exception

    Skilled nursing visits may be prior authorized for up to 90 days to prevent admissions to acute care hospitals or nursing facilities. Home health agencies request prior authorization using the MA State Plan process. SNV payments cannot duplicate ICF/DD payments.

    Covered services

    Skilled nursing visits include any of the following:

  • • Completion of a procedure requiring substantial and specialized nursing skill such as administration of intravenous therapy, intra-muscular injections and sterile procedures
  • • Consumer teaching and education/training requiring the skills of a professional nurse
  • • Observation, assessment and evaluation of the physical and/or mental status of the person
  • All skilled nursing visits must be:

  • • Made in accordance with the accepted standard of medical and nursing practice in accordance with the Minnesota Nurse Practice Act
  • • Made in accordance with the plan of care or service plan
  • • Ordered by a physician.
  • Non-covered services

    Skilled nursing visits to the place of residence of a person are not covered when made for the sole purpose to:

  • • Directly observe medication administration for communicable tuberculosis (may be billed under procedure code X5699 TB Direct Observation Therapy)
  • • Monitor medication compliance with an established medication program
  • Public health nursing (PHN) clinic visit
  • • Set up or administer oral medications, pre-fill a medication or for any other activity that can be delegated to a family member
  • • Supervise a home health aide (supervision may be done during a SNV where the visit qualifies for payment)
  • • Train other home health agency workers.
  • Nursing visits that are required by Medicare but do not qualify as SNVs are an administrative expense for agencies and cannot be billed to MA. Examples include Medicare evaluation or administrative nursing visits required by Medicare.

    Provider standards and qualifications

    Only Medicare certified home health agencies may provide skilled nursing visits. Medicare-certified home health agencies must employ the RNs or LPNs. Visits may be conducted face-to-face or via telehomecare technology. Assessment of need determines the length of time for the skilled nursing visit.

    Process and procedure

    1. MA State Plan services
    2. BI/CAC/CAD waivers
    3. DD Waiver
    For information about rates, see DHS – Long-term services and supports rates changes.

    Process and procedure: SNV – MA State Plan services

    Effective Date: 10/1/03

    Review Date: 10/1/03

    Access

    To initiate service, anyone may make a referral directly to a Medicare-certified home health agency.

    Assessment

    Registered nurse of the Medicare-certified home health agency completes an assessment that:

  • • Determines outcome for visit(s)
  • • Identifies the needs of the person
  • • Includes an individualized plan of care or service plan
  • • Is documented in the record of the person
  • Authorization

    Medicare-certified home health agency submits the following to DHS:

  • • Home Health Certification and Plan of Care
  • • Physician orders
  • Service Agreement DHS-3070 (PDF) – submit via ITS software or mail paper form.
  • DHS reviews material submitted for completeness, need for service and number of visits. If approved, DHS provides:

  • • Temporary authorization (a one-time authorization for up to 45 days maximum)
  • • Long-term service authorization (an authorization for up to one year, depending on the needs of the person).
  • Limitations

    No more than two visits per day per person are permitted. Up to nine visits per calendar year per person are allowed without requiring prior authorization.

    All telehomecare visits must receive prior authorization.

    Process and procedure: SNV – BI, CAC and CADI waivers

    Effective Date: 10/1/03

    Review Date: 10/1/03

    Access

    To initiate service, a referral is made by a waiver case manager/service coordinator to an approved Medicare-certified home health agency.

    Assessment

    Use the long-term care consultation process to determine need for service. Registered nurses of the Medicare-certified home health agency:

  • • Complete assessments to determine skilled need and develops care plan
  • • Use agency forms with retention of documents in the person’s file
  • • Obtain physician orders.
  • Authorization

    Lead agencies:

  • • Complete authorizations for SNV(s) with entry into the MMIS service agreements
  • • Base length of authorizations on the needs of people and/or the length of current service agreements
  • Limitations

    Lead agencies need to authorize all visits including telehomecare visits. No more than two visits per day per person are permitted.

    Process and procedure: SNV – DD Waiver

    Effective Date: 10/1/03

    Review Date: 10/1/03

    Access

    To initiate service, lead agencies make referrals to approved Medicare-certified home health agencies.

    Assessment

    Use the developmental disability screening process to assess determination of need for service. Registered nurses of the Medicare-certified home health agency:

  • • Complete agency assessments to determine need and develops care plan
  • • Obtain physician orders
  • • Use agency forms with retention of documents in the person’s file
  • Authorization

    Lead agencies:

  • • Complete authorization for SNV with entry into the MMIS service agreement
  • • Base length of authorizations on the medical needs of the people and/or the length of current service agreement
  • Limitations

    Lead agencies prior authorize all visits including telehomecare visits. No more than two visits per day per person are permitted.

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