HI 00601.330 Definition of Intermittent
To be considered in need to “intermittent” skilled nursing care, an individual must require a skilled nursing service at least
once every 60 days. Cases in which a skilled nursing service is required only once
every 60 days are the exception rather than the rule. Since the need for an intermittent
skilled nursing service makes the individual eligible for other covered home health
services, home health claims based on such a service are carefully reviewed by the
intermediary. Intermittent skilled nursing care could include infrequent, yet intermittent,
observation and evaluation visits for the blind diabetic at least every 90 days, or
the changing of an indwelling silicone catheter at 90-day intervals. A one-time nursing
service is not considered a need for intermittent skilled nursing care. However, when
the need for a skilled nursing visit at least once every 60 days is medically predictable,
but a situation arises after the first visit making additional visits unnecessary,
e.g., the patient dies or is hospitalized, the one visit made is reimbursable.
Although most patients require services no more frequently than several times a week,
medicare will pay for part-time medically reasonable and necessary skilled nursing
care 7 days a week for a short period of time (2-3 weeks).
A person expected to need more or less full-time skilled nursing care over an extended
period of time; i.e., a patient who requires institutionalization, would usually not
qualify for home health benefits.