Criteria for Certifying §1819(a)(1) of the Act Status of LTC

2166 - Criteria for Certifying §1819(a)(1) of the Act Status of LTC Facilities Other Than SNFs (Rev. 1, 05-21-04) As indicated above, SNFs meet §1819(a)(1) requirements, as do LTC facilities in States where licensure laws require it. In other situations, a facility or a part of a facility meets the standard set forth in §1819(a)(1) of the Act for purposes of determining spell of illness status if it meets each of the following: (See Exhibit 10, Form CMS-1539A, “Certification and Transmittal for Spell of Illness Determination.”) 2166A - Nursing Services (Rev. 1, 05-21-04) Nursing services are provided under the direction or supervision of one or more RNs or licensed practical or vocational nurses without regard to whether the facility has the nurse staffing requirement “waived.” The SA considers this condition met even if the nurse is also the administrator of the facility or is employed on a part-time basis. 2166B - 24-Hour Nursing Services (Rev. 1, 05-21-04) Nursing personnel are on duty 24 hours a day. The term “nursing personnel” includes RNs, licensed practical or vocational nurses without regard to whether they are “waived,” practical nurses, student nurses, nurse aides, and orderlies. 2166C - Nurse-Bed Ratio (Rev. 1, 05-21-04) The number of full-time equivalent nursing personnel to the number of beds is not less than an average ratio of 1 to 15 per shift. NOTE: Generally, there will be a close equivalency between the number of beds and the average number of patients in an institution. When circumstances indicate a significant discrepancy in these factors, the ratio of nurses to the average patient census should be used in certifying §1819(a)(1) status. A facility that has three 8-hour shifts must have a minimum of the equivalent of three full- time nursing personnel during a 24-hour period for each 15 beds. It is not necessary that the 1 to 15 ratio be maintained for each shift, but the average of all shifts must be at least 1 to 15. In determining the ratio, the SA counts nurses who are also administrators as nursing personnel. 2166D - Other Services (Rev. 1, 05-21-04) Bed and board are provided to inpatients in connection with the furnishing of nursing care, plus one or more medically-related health services such as physicians’ services, physical, occupational or speech therapy, diagnostic and laboratory services, and administration of medication. (Social, diversional, or recreational services provided by the institution are not considered medically-related health services.)