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.
However, if the skilled services furnished the patient are the primary purpose for
the total care provided, the custodial care exclusion does not apply.
If it is medically necessary to have the services of a nurse available to the patient
at all times, the need for this service alone establishes that the primary purpose
of the total care is the provision of this skilled service.
When a patient does not require nursing services, the primary purpose of the total
care furnished is generally to assist him in meeting his activities of daily living.
Where the need for nursing services is only minimal, the furnishing of skilled services
is the primary purpose of the total care furnished only if all the skilled services
furnished in view of the patient's condition are such that they could not be performed
outside the institutional setting. These situations will probably be limited to those
where an individual is hospitalized for the running of extensive diagnostic tests.