woodbury

Skilled Nursing

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Skilled Nursing - Requirements To Receive

Description

Skilled nursing is a service prescribed by a physician and consists of part-time
or intermittent nursing care provided by registered or licensed practical nurses,
in accordance with Chapter 464, F.S.
A nursing assessment may be performed to determine the need for the
service, or to evaluate the recipient for care plan development.
Reimbursement for a nursing assessment is considered two hours of service
at the registered nurse rate. Only registered nurses may perform an
assessment. Nursing assessments should be updated annually, or if there is a
significant change in the recipient's health status.

Limitations

This service supplements nursing services available through the Medicaid
State Plan Home Health Program. Skilled nursing services are available under
Medicaid State Plan to children under the age of 21 with complex medical
needs. Licensed nursing is available to children and adults when determined
medically-necessary by the Medicaid State Plan Program and related to the
care of a medical condition.
Nursing services not available to recipients under the Medicaid State Plan may
be paid for by the DD waiver, if the appropriate, qualified professional
determines on behalf of the APD, that the standards for medical necessity are
met. The DD waiver may pay only for those medically necessary services not
covered by the Medicaid State Plan Home Health Program.
The recipient shall receive no more than 32 units of this service per day. A
unit is defined as a 15-minute time period or portion thereof. This service may
be provided concurrently (at the same time and date) with another service
being furnished by another provider. Skilled nursing services do not include
time spent completing the OASIS assessment.
Note: Refer to the Florida Medicaid Home Health Services Coverage and
Limitations Handbook for additional information on Medicaid State Plan
coverage. The handbooks are available on the Medicaid fiscal agent’s Web
Portal at http://mymedicaid-florida.com. Click on Public Information for
Providers, then on Provider Support, and then on Provider Handbooks. The
handbook is incorporated by reference in rule 59G-4.130, F.A.C.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the
provider:
1. *Copy of claim(s) submitted for payment;
2. *Nursing care plans and revisions;
3. *Service log;
4. *Nursing assessment (must be completed at time of first claim submission
and annually thereafter);
5. Daily progress notes;
6. *Prescription for service; and
7. List of duties to be performed by the nurse.
Documentation to be submitted to the waiver support coordinator by the
provider:
1. Copy of service logs, monthly;
2. Nursing care plan at time of initial claim submission and annually
thereafter;
3. Nursing assessment, prior to or at time of claim submission; and
4. Copy of original prescription for service.
*Indicates reimbursement documentation.

Place of Service

Skilled nursing services shall be provided at the recipient’s place of residence
and other waiver service sites, such as an adult day training program.
Special
Considerations
Skilled nursing services shall not be used for the ongoing medical oversight
and monitoring of direct care staff or caregivers in a licensed residential facility
or in the recipient’s own or family home.

Skilled Nursing Services Provider Requirements

Skilled Nursing Services Provider Requirements

Provider Qualifications
Providers of skilled nursing services shall be nurses registered or licensed in
accordance with Chapter 464, F.S.
Nurses may provide this service as independent vendors or as employees of
home health, hospice agencies or nurse registries licensed in accordance
with Chapter 400, parts III or IV, F.S.
Home health agencies must also be enrolled in the Medicaid home health
program and meet Federal Conditions of Participation in accordance with 42
CFR Part 484.

Training Requirements
Proof of training in the areas of Cardiopulmonary Resuscitation (CPR),
HIV/AIDS and infection control is required within 30 days of initially providing
skilled nursing services. Proof of annual or required updated training shall be
maintained on file for review.
The provider is responsible for all training requirements outlined in the Core
Assurances.

Note: Refer to the Core Assurances in Appendix A for the provider training
requirements.