HI 00601.135 Covered Level of Care
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. he needs skilled nursing care or other skilled rehabilitation services for any of the conditions for which he received medically necessary inpatient hospital care, or for a condition which arose while he was 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 him 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 him.
See HI 00601.010 D. for related instructions.