Skilled Nursing Facility Criteria

Skilled care is health care that is provided to treat, manage, observe and evaluate care related to an illness or injury.  The services provide multidisciplinary skilled services to restore or enhance function after an illness or injury. 

ConnectCare will cover skilled nursing facility only if all of the following are true:

1. The physician has ordered the services a patient needs for SNF care, which require the skills of professional personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists or audiologists and other qualified healthcare professionals as needed.
2. The patient requires the skilled care on a daily basis and the services must be ones that, as a practical matter, can only be provided in a SNF. If you are in a SNF for skilled rehabilitation services only, your care is considered daily care even if the therapy services are offered just 5-6 days a week.
3. The skilled services must be reasonable and necessary for the diagnosis or treatment of the patient’s condition.

Custodial care is care that can be given by non-professional staff and is not considered skilled care.  Custodial care is not covered under your medical plan.

Approved:  5/07

Reviewed:  1/09, 1/13,3/14, 1/15, 1/16, 4/17, 1/18, 1/19, 2/20

Revised:  2/08, 3/10, 2/11, 1/12, 1/15, 1/16