Source: https://www.aadns-ltc.org/Resources/DNS-Navigator/details/post/pdpm-prep-brush-up-on-skilled-nursing-services/2019-01-16
Timestamp: 2019-04-20 18:09:46+00:00

Document:
Under skilled nursing, SNFs can provide direct skilled nursing services (e.g., intravenous or intramuscular injections and intravenous feeding) or skilled-management nursing services, including management and evaluation of a patient care plan, observation and assessment of a patient’s condition, and teaching and training activities. “Providers need to understand that nursing will be a viable primary skilled service under PDPM, so it’s a good idea to master some of these nursing skills that you may not have used in a while,” says McCarthy.
· 30 - Skilled Nursing Facility Level of Care – General: Explains the four factors needed to meet a skilled level of care.
§ 30.1 – Administrative Level of Care Presumption. Note: For additional information on how administrative presumption works under PDPM, see the Administrative Level of Care Presumption Under PDPM fact sheet.
o 30.2.1 - Skilled Services Defined: Explains the two components required for a service to be skilled and why a skilled service may be required.
o 30.2.2 - Principles for Determining Whether a Service is Skilled: Explains the role inherent complexity plays in skilled services and provides examples of how to determine whether a service is skilled.
§ 30.2.2.1 – Documentation to Support Skilled Care Determinations: Does not prescribe documentation formats, but explains core content requirements needed for medical review, as well as providing examples of vague or subjective documentation that would not be sufficient to validate the need for skilled care.
§ 30.2.3.1 - Management and Evaluation of a Patient Care Plan: Explains—with examples—when the development, management, and evaluation of a patient care plan constitute skilled nursing services.
§ 30.2.3.2 - Observation and Assessment of Patient’s Condition: Explains—with examples—when the likelihood of change in a patient’s condition makes observation and assessment skilled services.
§ 30.2.3.3 - Teaching and Training Activities: Explains—with examples—when teaching a patient how to manage their treatment regimen is a skilled service.
o 30.2.4 - Questionable Situations: Explains scenarios that raise yellow flags, requiring SNFs to show specific evidence of the need for and provision of skilled services.
§ 30.3 - Direct Skilled Nursing Services to Patients: Explains coverage requirements for direct skilled nursing services and offers examples of these services.
§ 30.5 - Nonskilled Supportive or Personal Care Services: Discusses services that are generally nonskilled but can be skilled if special medical complications require skilled staff to perform or supervise care or to observe the patient.
§ 30.6 - Daily Skilled Services Defined: Explains what daily skilled services means, including how many days per week skilled rehab, skilled nursing, and skilled restorative nursing services must be needed and provided.

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