Intermittent nursing services ordered by a physician for a recipient whose illness, injury, physical, or mental condition creates a need for the service. Services under the direction of an RN are provided in the recipient’s residence by an RN, or LPN; and provided under a plan of care or service plan that specifies a level of care which the nurse is qualified to provide.
Medicare Certified, Class A Licensed home health agencies enrolled with MHCP.
Recipients must be eligible under one of the following programs:
An assessment is not required for SNV; however, SNVs must be ordered by a physician and must be medically necessary.
The following services must be authorized prior to being delivered by the provider:
• Skilled nurse services above nine visits per recipient, per calendar year (MA home care)
• All Tele-Home-Care
• Waiver recipients require prior authorization from their case manager
The authorization cannot begin before the date DHS receives the complete Service Agreement (SA) request with all required documentation. Refer to the Service Agreement Quick Reference Guide for the complete process.
• Services provided according to the recipient’s written plan of care or service plan.
• Intermittent home visits to initiate and complete professional nursing tasks based on a recipient’s need for service as assessed to maintain or restore optimal health. Visits are made by a registered nurse (RN) or licensed practical nurse (LPN), employed by a Medicare certified home health agency, under the supervision of an RN. If the necessary medical services are more complex and require more time than can be performed in a single or twice daily skilled nurse visit, private duty nursing services is an appropriate option.
• Observation, assessment, and evaluation of a person’s physical or mental health status. This may be covered when the likelihood of a change in condition requires skilled nursing personnel to identify and evaluate the need for possible modification of treatment or initiation of additional medical procedures until the recipient’s treatment regiment is stabilized.
• A procedure that requires substantial and specialized nursing skill such as administration of intravenous therapy, intra-muscular injections, procedures such as sterile catheter insertion or sterile wound cares.
• Teaching and training that requires the skills of a nurse. Examples could include, teaching self-administration of injectible medications or a complex range of medications; teaching a newly diagnosed diabetic person or caregiver on all aspects of diabetic management; teaching self-catheterization or bowel and/or bladder training.
• Postpartum visits to new mothers and their newborn infants if the mother and her newborn are discharged early from the hospital. Early discharge means less than 48 hours following a vaginal delivery or less than 96 hours following a caesarian section. Post delivery care includes a minimum of one home visits by a licensed RN. The RN must provide parent education, assistance and training in breast and bottle-feeding and conduct any necessary and appropriate clinical tests. The licensed RN must make the home visit within four days following hospital discharge. A separate plan of care is needed for the mother and newborn.
• Community health nursing visits provided by a public health agency or home health agency for the sole purpose of maternal, child, and adult health promotion ONLY when an authorized skilled nursing service is provided at the same visit.
• Two visits per day can be authorized when necessary.
• Tele-home-care visits. Coverage of tele-home-care is limited to 2 visits per day and all of the visits must be prior authorized.
• DHS may authorize skilled nurse visits for fewer than 90 days for a recipient residing in an ICF/DD to prevent admission to a hospital or nursing facility, if the ICF/DD is not required to provide the nursing services. The home health agency must obtain prior authorization.
• Venipuncture from a peripheral site, the Home Health provider can submit a request for prior authorization if they have determined and documented:
• That there is not an available lab service that can visit the recipient’s home to obtain the venipuncture from the peripheral site
• That there is not a service reasonably available to the recipient outside of his/her place of residence
• The recipient no longer qualifies for Medicare Part A skilled nurse services
• Usual and customary equipment and supplies that are necessary to complete a SNV (i.e., stethoscope, nail clippers, sphygmomanometer, alcohol wipes, etc.)
• SNV for the sole purpose of supervising a home health aide or PCA. However, supervision may be done during a SNV that qualified for payment
• SNV for the sole purpose of monitoring medication compliance, with an established medication program for a recipient
• SNV for the sole purpose of monitoring a recipient’s overall physical status, when the recipient’s physical status has not changed and the person is considered stable
• SNV to set up or administer oral medications; pre-fill injections, such as insulin syringes for an adult recipient when the need can be met by an available pharmacy; or the recipient is physically and mentally able to self-administer or pre-fill a medication; or if the activity can be delegated to a family member
• When the sole purpose of the visit is to train other home health agency workers;
• When the visit is performed in a place other than the recipient’s residence
• For Medicare evaluation or administrative nursing visits required by Medicare but not qualifying as a SNV. (These visits are an administrative expense for the Medicare certified agency and cannot be billed to MA)
• SNV provided by an RN that is employed by a Personal Care Provider Organization (PCPO) or non-Medicare certified private duty nursing agency
• A communication between the home care nurse and recipient that consists solely of a telephone conversation, facsimile, electronic mail or a consultation between two health care practitioners is not considered a tele-home-care visit
MA recipients that are not on a waiver are eligible for 9 skilled nurse visits per calendar year without authorization. All waiver recipients must have a valid SA including SNV.
CFR 42, part 484.30 HIM Section 232.9
Report/Rate this page
MS 256B.0625 Subd 2 (Covered services Skilled and Intermediate Nursing Care)
MS 256B.0651 (Home Care Services)
MS 256B.0653 (Home Health Agency Services)