Skilled Nursing

Skilled Nursing Farmington NM

Skilled Nursing Farmington NM

Skilled nursing care consists of those services that must be performed by a registered nurse or licensed practical (vocational) nurse, and meet all of the following criteria for skilled nursing services: 

  1. Pursuant to physician orders, the service(s) is so inherently complex that it can be safely and effectively performed only by, or under the supervision of, a licensed nurse to achieve the medically desired result; and
  2. The skilled nursing care must be provided on an intermittent* or hourly** basis; and
  3. The skilled nursing service is not custodial*** in nature; and
  4. The skilled nursing service(s) must be reasonable and necessary for the treatment of the illness or injury, that is, the services must be consistent with the unique nature and severity of the member’s illness or injury, his or her particular medical needs, and accepted standards of medical and nursing practice, without regard to whether the illness or injury is acute, chronic, terminal, or expected to last a long time.
  • Skilled home health nursing care is the provision of intermittent skilled services to a member in the home for the purpose of restoring and maintaining his or her maximal level of function and health.  These services are rendered in lieu of hospitalization, confinement in an extended care facility, or going outside of the home for service.

Subject to applicable benefit plan terms and limitations, Aetna considers skilled home health nursing services medically necessary when all of the following criteria are met:

  1. The member is homebound because of illness or injury (i.e., the member leaves home only with considerable and taxing effort and absences from home are infrequent, or of short duration, or to receive medical care); and
  2. The nursing services provided are not primarily for the comfort or convenience of the member or custodial in nature; and
  3. The services are ordered by a physician and are directly related to an active treatment plan of care established by the physician; and
  4. The services are provided in lieu of a continued hospitalization, confinement in a skilled nursing facility (SNF), or received outpatient services outside of the home; and
  5. The skilled nursing care is appropriate for the active treatment of a condition, illness, disease, or injury to avoid placing the member at risk for serious medical complications; and
  6. The skilled nursing care is intermittent or hourly in nature*; and
  7. The treatment provided is appropriate for the member’s condition including the amount of time spent providing the service as well as the frequency and duration of the services.

 

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Guardian Angel Home Health and Hospice
2800 N. Hutton Ave
Farmington, NM 87402
PH: 505.564.9002
FAX: 505.564.9022