Nonskilled Supportive or Personal Care Services

30.5 - Nonskilled Supportive or Personal Care Services (Rev. 1, 10-01-03) A3-3132.4, SNF-214.4 The following services are not skilled services unless rendered under circumstances detailed in §§30.2: • Administration of routine oral medications, eye drops, and ointments (the fact that patients cannot be relied upon to take such medications themselves or that State law requires all medications to be dispensed by a nurse to institutional patients would not change this service to a skilled service); • General maintenance care of colostomy and ileostomy; • Routine services to maintain satisfactory functioning of indwelling bladder catheters (this would include emptying and cleaning containers and clamping the tubing); • Changes of dressings for uninfected post-operative or chronic conditions; • Prophylactic and palliative skin care, including bathing and application of creams, or treatment of minor skin problems; • Routine care of the incontinent patient, including use of diapers and protective sheets; • General maintenance care in connection with a plaster cast (skilled supervision or observation may be required where the patient has a preexisting skin or circulatory condition or requires adjustment of traction); • Routine care in connection with braces and similar devices; • Use of heat as a palliative and comfort measure, such as whirlpool or steam pack; • Routine administration of medical gases after a regimen of therapy has been established (i.e., administration of medical gases after the patient has been taught how to institute therapy); • Assistance in dressing, eating, and going to the toilet; • Periodic turning and positioning in bed; and • General supervision of exercises, which have been taught to the patient and the performance of repetitious exercises that do not require skilled rehabilitation personnel for their performance. (This includes the actual carrying out of maintenance programs where the performances of repetitive exercises that may be required to maintain function do not necessitate a need for the involvement and services of skilled rehabilitation personnel. It also includes the carrying out of repetitive exercises to improve gait, maintain strength or endurance; passive exercises to maintain range of motion in paralyzed extremities which are not related to a specific loss of function; and assistive walking.) (See Medicare Benefit Policy Manual, Chapter 1, “Inpatient Hospital Services.”)