Federal regulations published on May 12, 1998 made significant changes to the Medicare skilled nursing facility (SNF) level of care requirements.  In addition to establishing a new SNF payment system, the regulations eliminate management of a patient's care plan, observation and assessment, and patient education as examples of skilled nursing services which may trigger Medicare coverage.  The changes therefore may significantly limit certain beneficiaries' ability to receive Medicare coverage for skilled nursing facility care.

Because the regulations defining skilled services have been incorporated by reference in the Medicare home health regulations, advocates were concerned that the revisions would have a negative impact on Medicare home care coverage as well as skilled nursing facility coverage.  In response to our inquiries, HCFA issued a directive on August 11, 1998 stating clearly that these services are still recognized as skilled nursing for Medicare home health coverage.

Click here to view the Directive.