C. Other questionable situations

When any of the following circumstances exist, there must be evidence that skilled nursing service is also concurrently required and received:

1. The primary service is one or more of the following: a. Oral medication b. Skin care to prevent decubiti c. Restraints d. Frequent laboratory tests

2. The patient is capable of independent ambulation, dressing, feeding, and hygiene;

3. The patient has outside privileges;

4. The diagnosis shown is not of a type which is sufficiently specific to indicate skilled treatment regimen; i.e., the diagnosis is chronic brain syndrome, senility, arteriosclerosis, “old” CVA, etc.

5. Return to a hospital preceding the SNF stay occurred shortly after the expiration of 60 days from the last discharge from hospital or SNF;

6. Long-term hospitalization (60 days or longer) occurred prior to the SNF admission;

7. Discharge from the SNF occurred after about 100 days of care (or there have been many discharges from the SNF after nearly 100 days);

8. Transfer occurred from an SNF to a hospital for three, four, or five days followed by an immediate admission to an SNF.