A. Skilled services defined

For Medicare purposes, a skilled service is one which must be furnished by or under the general supervision of skilled personnel to assure the safety of the patient and achieve the medically desired result.

In determining whether skilled care was needed and provided, the intermediary's medical staff keeps in mind that the patient's eligibility for benefits depends on their need for skilled care and not on their potential for recovery. If a beneficiary requires daily skilled services to prevent deterioration of their condition or to sustain their current capabilities and such services as a practical matter can only be provided by an SNF on an inpatient basis, the beneficiary would be eligible for extended care benefits even though they may have very little or no rehabilitation potential. For example, a terminal cancer patient requiring daily skilled services on an inpatient basis may be eligible for extended care benefits even though their life expectancy may be no more than a few months. Such a patient, who may require palliative treatment, periodic “tapping” to relieve fluid accumulation, and careful skin care and hygiene to minimize discomfort, is receiving a covered level of care. Thus, the controlling factor in determining whether a person is receiving covered care is the level of care and medical supervision that the patient requires, rather than considerations such as diagnosis, type of conditions, or degree of functional limitation.