HI 00601.020 Nursing and Other Services

A. General

Nursing and other related services, use of hospital facilities, and medical social services ordinarily furnished by the hospital for the care and treatment of inpatients are covered under hospital insurance.

The services of a private-duty nurse or other private-duty attendant are not covered. Private-duty nurses or private-duty attendants are registered professional nurses, licensed practical nurses, or any other trained attendant whose services ordinarily are rendered to, and restricted to, a particular patient by arrangement between the patient and the private-duty nurse or attendant. Such persons are engaged or paid by an individual patient or by someone acting on his behalf, including a hospital that initially incurs the costs and looks to the patient for reimbursement for such noncovered services.

When the hospital acts on behalf of a patient, the services of the private-duty nurse or other attendant under such an arrangement are not inpatient hospital services regardless of the control which the hospital may exercise with respect to the services rendered by such private-duty nurse or attendant.

If the hospital engages the services of a nurse anesthetist or other nonphysician anesthetist (either on a salary or fee-for-service basis) under arrangements which provide for billing to be made by the hospital, the cost of the service when provided to an inpatient would be covered under Part A.

B. Medical social services

Medical social services are those social services which contribute meaningfully to the treatment of a patient's condition. Such services include, but are not limited to; (1) assessment of the social and emotional factors related to the patient's illness, his need for care, his response to treatment, and his adjustment to care in the facility; (2) appropriate action to obtain case work services to assist in resolving problems in these areas; (3) assessment of the relationship of the patient medical and nursing requirements to his home situation, his financial resources, and the community resources available to him in making the decision regarding his discharge.


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http://policy.ssa.gov/poms.nsf/lnx/0600601020
HI 00601.020 - Nursing and Other Services - 04/03/2015
Batch run: 04/03/2015
Rev:04/03/2015