Nf: Coverage And Limitations

NFs must provide regular, health-related care and services to participants who require additional care and services due to a mental or physical condition above room, board, and supervision alone. (7-1-26) 01. Minimum Coverage. Minimum services and supplies include: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 473 Page 101 a. Room and board; (7-1-26) b. Bed and bathroom linens; (7-1-26) c. Nursing care, including special feeding if needed; (7-1-26) d. Personal services; (7-1-26) e. Supervision when required by the patient's condition; (7-1-26) f. Special diets prescribed by a physician; (7-1-26) g. All common over-the counter medicine chest supplies; (7-1-26) h. Dressings. Applications using prescription medications or aseptic techniques must be completed by an RN; (7-1-26) i. Administration of intravenous, subcutaneous, or intramuscular injections and infusions, enemas, catheters, bladder irrigations, and oxygen; (7-1-26) j. Application or administration of all drugs; (7-1-26) k. All common disposable medical supplies; (7-1-26) l. Social and recreational activities; and (7-1-26) m. Any reusable item commonly needed by patients expected to be available in a NF, such as bed rails, canes, crutches, walkers, wheelchairs, traction equipment, and other DME. (7-1-26) 02. Skilled Services. (7-1-26) a. Overall development, management, and evaluation of a resident’s service plan, based on a physician's orders, when a patient's physical or mental condition or aggregate PCS tasks require technical or professional staff to meet their needs, promote recovery, and assure medical safety. (7-1-26) b. Ongoing assessment of rehabilitation needs concurrent with the management of a resident's service plan, including tests and measurements of range of motion, strength, balance, coordination, endurance, functional ability, ADLs, perceptual deficits, and speech, language, or hearing disorders. (7-1-26) c. Professional observation and assessment of a resident's changing condition required to identify and evaluate whether treatment modification or additional medical procedures to stabilize a condition are needed. (7-1-26) 03. Limitations. (7-1-26) a. Services requiring skilled nursing staff include: (7-1-26) i. Intravenous injections or feedings and intramuscular or subcutaneous injections required on more than one (1) shift; (7-1-26) ii. Nasopharyngeal feedings and aspiration; (7-1-26) iii. Tracheotomy aspiration; (7-1-26) iv. Catheter insertion, sterile irrigation, and replacement; (7-1-26) v. Treating extensive decubitus ulcers or other widespread skin disorders; (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 474 Page 102 vi. Heat treatments specifically ordered by a physician as part of treatment and requiring nurse observation to adequately evaluate a resident's progress; and (7-1-26) vii. Initial phases of a regimen involving oxygen administration. (7-1-26) b. Services requiring physical or occupational therapists include: (7-1-26) i. Therapeutic exercises or activities must be performed by or under supervision to ensure resident safety and treatment effectiveness; (7-1-26) ii. Gait evaluation and training to restore function in a resident whose ability to walk is impaired by neurological, muscular, or skeletal abnormality; (7-1-26) iii. Ultrasound, short-wave, and microwave therapy treatments; and (7-1-26) iv. Other treatment and modalities including hot pack, hydroculator, infrared treatments, paraffin baths, and whirlpool for residents with circulatory deficiency, desensitization, open wounds, fractures, or other complications. (7-1-26)