Skilled care
Care so complex that only professional or technical staff can safely provide or supervise it — the test Medicare coverage turns on.
What it means
A service is skilled where it is so inherently complex that it can be performed safely and effectively only by, or under the supervision of, professional or technical personnel.
A service is not skilled merely because a licensed nurse performed it. Where it could be done safely by unlicensed staff without a nurse's direct supervision, it is not skilled even if a nurse did it.
A normally unskilled service can become skilled where special medical complications require professional involvement — but the complication and the reason must be documented in the physician's orders and the nursing or therapy notes.
Why it matters
It is the line between what Medicare pays for and what a family pays for, in every setting.
It is decided by what the chart says, which is why the request to make is that the complication be recorded.
When you are likely to meet it
- When a nursing facility or home health agency says a parent no longer needs skilled care.
- When a home health referral is being considered.