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Intermittent Skilled Nursing Care

“Intermittent” has been defined as skilled nursing care that is either provided or needed for fewer than seven days each week, or for fewer than eight hours each day for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional care is finite and predictable). To meet the requirement for “intermittent” skilled nursing care, a patient must have a medically predictable, recurring need for skilled nursing services. In most instances, this definition will be met if a patient requires a skilled nursing service at least once every 60 days.

A physician may order a skilled home health visit less frequently than once every 60 days. If there exists an extraordinary circumstance of anticipated patient need that has been documented in the patient's plan of care (in accordance with 42 CFR 409.43(b)), a skilled visit frequency of less than once every 60 days would be covered if it is specifically ordered by a physician in the patient's plan of care and is considered to be a reasonable, necessary and medically predictable skilled need for the patient in the individual circumstance. A one time order, such as to administer gamma globulin following exposure to hepatitis, would not be considered a need for “intermittent” skilled nursing care since a recurrence of the problem that would require this service is not medically predictable.

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 seven days a week for a short period of time (two to three weeks). There may be a few cases involving unusual circumstances where the patient's prognosis indicates a medical need for daily skilled services beyond three weeks. As soon as the patient's physician makes this judgment, which usually should be made before the end of the three-week period, the HHA must forward medical documentation justifying the need for such additional services and include an estimate of how much longer daily skilled services will be required. A person expected to need full-time skilled nursing care over an extended period of time, e.g., a patient who requires institutionalization, usually would not qualify for home health benefits.