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.

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HI 00601.330 - Definition of "Intermittent" - 09/15/1989
Batch run: 01/27/2009