(a) To be considered a skilled service, the service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel.
(b) A condition that does not ordinarily require skilled services may require them because of special medical complications. Under those circumstances, a service that is usually nonskilled (such as those listed in § 409.33(d)) may be considered skilled because it must be performed or supervised by skilled nursing or rehabilitation personnel. For example, a plaster cast on a leg does not usually require skilled care. However, if the patient has a preexisting acute skin condition or needs traction, skilled personnel may be needed to adjust traction or watch for complications. In situations of this type, the complications, and the skilled services they require, must be documented by physicians' orders and nursing or therapy notes.
(c) The restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities. For example, a terminal cancer patient may need some of the skilled services described in § 409.33.
[48 FR 12541, Mar. 25, 1983, as amended at 59 FR 65493, Dec. 20, 1994]
Notes of Decisions
Exec. Dir. of the Off. of Vermont Health Access v. Sebelius, 698 F. Supp. 2d 436 (D. Vt. 2010).
· cites it 6× “” 42 C.F.R. § 409.32 (a). The Magistrate Judge notes that a patient whose condition does not ordinarily require skilled services, may require skilled services due to special medical complications.”
United States ex rel. Johnson v. Golden Gate Nat'l Senior Care, L.L.C., 223 F. Supp. 3d 882 (D. Minnesota 2016).
“” 42 C.F.R. § 409.32 (a). They do not include, for example, “[g]eneral supervision of exercises, which have been taught to the patient and the performance of repetitious exercises that do not require skilled rehabilitation personnel for their performance.”
Hirsch v. Bowen, 655 F. Supp. 342 (S.D.N.Y. 1987).
· cites it 4× “31 (b), and Hirsch did not suffer “special medical complications” caused by his pre-existing condition which would render the services reimbursable, 42 C.F.R. § 409.32 (b); and 3) Hirsch’s rehabi-latative treatment, which could qualify as *344 skilled care, 42 C.”
Child.'s Healthcare is a Legal Duty, Inc. v. Min De Parle, 212 F.3d 1084 (8th Cir. 2000).
· cites it 2× “” 42 C.F.R. § 409.32 (a). Personal care services, such as administration of routine oral medication, eye drops, ointments, changing dressings, and routine care of incontinent patients, are generally not skilled services and are excluded from reimbursement under the “custodial…”
Livinrite, Inc. v. Azar, 386 F. Supp. 3d 644 (E.D. Va. 2019).
“" 42 C.F.R. § 409.32 IV. Plaintiff first argues that the MAC's decision should be set aside because the MAC's decision that AdvanceMed's sampling methodology could be accurately replicated is arbitrary and capricious, incorrectly applies the relevant legal standards, and is not…”
Fox v. Bowen, 656 F. Supp. 1236 (D. Conn. 1987).
“42 C.F.R. § 409.32 provides: (a) The service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel.”
Pfalzgraf v. Shalala, 997 F. Supp. 360 (W.D.N.Y. 1998).
· cites it 3× “” 42 C.F.R. § 409.32 (a); see also Falk v. Chater, 1995 WL 798915 , at *3 (D.”
Troutman v. Cohen, 661 F. Supp. 802 (E.D. Pa. 1987).
“The federal regulations provide criteria for skilled services, 42 C.F.R. § 409.32 , and include a list of examples of skilled nursing and rehabilitation services.”
Hurley v. Bowen, 674 F. Supp. 421 (E.D.N.Y 1987).
· cites it 2× “” 42 C.F.R. § 409.32 (a). As noted above, plaintiff concedes that he no longer needed acute care after October 1, 1981 but challenges the AU’s conclusion that he neither required and nor received skilled care between October 2 and October 23.”
Roth v. Sec'y of Health & Human Servs., 606 F. Supp. 636 (W.D.N.Y. 1985).
“” 42 C.F.R. § 409.32 (a). Services which are not normally “skilled” are covered if the patient has complications requiring the attention of a professional.”
— 42 C.F.R. § 409.32(a) — 2 cases
— 42 C.F.R. § 409.32(c) — 1 case
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