HI 00401.260 Skilled Nursing Facility (SNF) Defined

Citations:

Social Security Act—Sec. 1861(j)

Regulations No. 5—Secs. 405.1101-405.1137

A skilled nursing facility (SNF) is an institution (or a distinct part of an institution, see HI 00401.265 ), such as a skilled nursing home or rehabilitation center, which has a transfer agreement in effect with one or more participating hospitals (see HI 00401.270 for transfer agreements and HI 00401.200 for definition of participating hospital), and which:

A. is primarily engaged in providing to inpatients skilled nursing care and related services for patients who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons,

B. has policies (developed with the advice of and periodically reviewed by a professional group including one or more physicians and one or more registered professional nurses) to govern the skilled nursing care and related medical or other services it provides,

C. has a physician, a registered professional nurse, or a medical staff responsible for the execution of such policies.

D. has a requirement that the health care of every patient must be under the supervision of a physician.

E. provides for having a physician available to furnish necessary medical care in cases of an emergency.

F. maintains clinical records on all patients,

G. provides 24-hour nursing service sufficient to meet nursing needs in accordance with the policies developed pursuant to B. above, and has at least one registered professional nurse employed full time,

H. provides appropriate methods and procedures for dispensing and administering drugs and biologicals,

I. has in effect a utilization review plan.

J. is licensed in accordance with State or local law, or is approved by the State or local licensing agency as meeting the licensing standards where State or applicable local law provides for the licensing of institutions of this nature, and

K. is in substantial compliance with health and safety requirements established by regulation.

L. supplies complete information as to the identity of each person who has an ownership interest of at least 10 percent; if it is organized as a corporation, the names of each officer and director; if organized as a partnership, the name of each partner; and agrees to report any such changes,

M. cooperates in an effective program of independent medical evaluation and audit of its patients, including the patient's need for skilled nursing services, and

N. meets the Life Safety Code of the National Fire Protection Association requirements applicable to nursing homes.

A qualified skilled nursing facility is one which meets all the requirements in the above definition.

The term SNF does not include any institution which is primarily for the care and treatment of mental diseases or tuberculosis. NOTE: Effective October 30, 1972, section 265 of the 1972 amendments made optional the rendering of medical social services by SNF's. Even though SNF's can participate in the Medicare program without offering such services. Medicare will continue to allow, as an element of cost, expenditures for medical social services provided by a facility for its inpatients. However, SNF's that continue to render social services must comply with the staffing and other standards for social services specified in the regulations.