Medicare Benefit Policy Manual (Pub. 100-02), Ch. 7 § 50.7.2
Application of this Policy Revision
50.7.2 - Application of this Policy Revision
(Rev. 1, 10-01-03)
A3-3119.7.D, HHA-206.7.D
Additional care covered by other payers discussed in §50.7.1 does not affect Medicare
coverage when the conditions listed below apply. A patient must meet the criteria for
Medicare coverage of home health services, before this policy revision becomes
applicable to skilled nursing services and/or home health aide services. The definition of
"intermittent" with respect to the need for skilled nursing care where the patient qualifies
for coverage based on the need for "skilled nursing care on an intermittent basis" remains
unchanged. Specifically:
1. This policy revision always applies to home health aide services when the patient
qualifies for coverage;
2. This policy revision applies to skilled nursing care only when the patient needs
physical therapy or speech-language pathology services or continued occupational
therapy, and also needs skilled nursing care; and
3. If the patient needs skilled nursing care but does not need physical therapy or
speech-language pathology services or occupational therapy, the patient must still
meet the longstanding and unchanged definition of "intermittent" skilled nursing
care in order to qualify for coverage of any home health services.