(a)
(1) Nursing care provided by or under the supervision of a registered professional nurse;
(2) Bed and board in connection with the furnishing of that nursing care;
(3) Physical, occupational, or speech therapy;
(4) Medical social services;
(5) Drugs, biologicals, supplies, appliances, and equipment;
(6) Certain medical services provided by an intern or resident-in-training;
(7) Certain other diagnostic or therapeutic services; and
(8) Other services that are necessary to the health of the patient and are generally provided by SNFs.
(b)
(2)
(c)
(1) The terms
(2) The term
(3) The term “swing-bed hospital” includes a CAH with swing-bed approval under subpart F of part 485 of this chapter.
(a)
(b)
(i) The patient's condition requires him to be isolated;
(ii) The SNF has no semiprivate or ward accommodations; or
(iii) The SNF semiprivate and ward accommodations are fully occupied by other patients, were so occupied at the
(2)
(3)
(i) None of the conditions of paragraph (b)(1) of this section is met, and
(ii) The private room was requested by the patient or a member of the family who, at the time of request was informed what the charge would be.
Medicare pays for physical, occupational, or speech therapy as posthospital SNF care if—
(a) It is furnished by the facility or under arrangements made by the facility, and
(b) Billing for the therapy is by or through the facility.
(a) Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as posthospital SNF care only if—
(1) They represent a cost to the facility;
(2) They are ordinarily furnished by the facility for the care and treatment of inpatients; and
(3) They are furnished to an inpatient for use in the facility.
(b)
(a) Except as specified in paragraph (b) of this section, Medicare pays for supplies, appliances, and equipment as posthospital SNF care only if—
(1) They are ordinarily furnished by the facility to inpatients; and
(2) They are furnished to inpatients for use in the facility.
(b)
(1) The item is one that the beneficiary must continue to use after leaving, such as a leg brace; or
(2) The item is necessary to permit or facilitate the beneficiary's departure from the facility and is required until he or she can obtain a continuing supply. Sterile dressings would be an example.
Medicare pays for medical services furnished by an intern or a resident-in-training as posthospital SNF care if—
(a) The intern or resident is in a participating hospital with which the SNF has in effect an agreement for the transfer of patients and exchange of medical records or in a hospital that has a swing-bed approval; and
(b) The intern or resident furnishes the services under a hospital teaching program approved in accordance with the provisions of § 409.15.
Medicare pays for other diagnostic or therapeutic services as posthospital SNF care if they are provided by a participating hospital with which the SNF has in effect an agreement for the transfer of patients and exchange of clinical records, or by a hospital or a CAH that has a swing-bed approval.