Skilled nurse visits are intermittent nursing services ordered by a physician for a recipient 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 recipient’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.
Medicare-certified home health agencies with a comprehensive home care license.
Recipients must be eligible under one of the following programs:
An assessment is not required for SNV; however, SNVs must be ordered by a physician and must be medically necessary.
The following services must be authorized before being delivered:
• Skilled nurse services above nine visits per recipient, per calendar year (MA home care)
• All telehomecare
• Waiver services (the case manager must give the prior authorization)
The authorization cannot begin before the date DHS receives the complete Service Agreement (SA) request with all required documentation.
• Services provided according to the recipient’s written plan of care or service plan.
• Intermittent home visits to initiate and complete professional nursing tasks based on a recipient’s need for service as assessed to maintain or restore optimal health. Visits are made by a registered nurse (RN) or licensed practical nurse (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, private duty nursing 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 recipient’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 caesarian 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
• Usual and customary equipment and supplies that are necessary to complete a SNV (that is, stethoscope, nail clippers, sphygmomanometer, alcohol wipes)
• SNV for the sole purpose of supervising a home health aide or PCA. 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 recipient
• SNV for the sole purpose of monitoring a recipient’s overall physical status, when the recipient’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 recipient when the need can be met by an available pharmacy; when the recipient 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 recipient’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 non-Medicare certified private duty 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
MA recipients that are not on a waiver are eligible for 9 skilled nurse visits per calendar year without authorization. All waiver recipients must have a valid service agreement including SNV.
CFR 42, part 484.30 HIM Section 232.9
Report/Rate this page
Minnesota Statutes 256B.0625 Subd 2 (Covered services Skilled and Intermediate Nursing Care)
Minnesota Statutes 256B.0651 (Home Care Services)
Minnesota Statutes 256B.0653 (Home Health Agency Services)