TN 6 (10-22)
The following criteria apply to SNF admissions on or after January 1, 1973:
An individual is deemed to be receiving a covered level of posthospital extended care
if A. on a daily basis, B. they need skilled nursing care or other skilled rehabilitation
services for any of the conditions for which they received medically necessary inpatient
hospital care, or for a condition which arose while they were in an SNF receiving
care for such a condition, and C. as a practical matter, such services can be provided
only in an SNF on an inpatient basis. A determination that a patient requires a covered
level of care must be based on a decision that all these factors are met.
If the primary purpose of the total care provided an individual is to assist them
in meeting the activities of daily living, the custodial care exclusion applies and
no payment can be made under the program for any of the care furnished them.
See HI 00601.010 D. for related instructions.