Skilled nursing care
(b) Skilled nursing care. (1) Skilled nursing care consists of those services that must, under State law, be performed by a registered nurse, or practical (vocational) nurse, as defined in 484.115 of this chapter, meet the criteria for skilled nursing services specified in 409.32, and meet the qualifications for coverage of skilled services specified in 409.42(c). See 409.33(a) and (b) for a description of skilled nursing services and examples of them. (i) In determining whether a service requires the skill of a licensed nurse, consideration must be given to the inherent complexity of the service, the condition of the beneficiary, and accepted standards of medical and nursing practice. (ii) If the nature of a service is such that it can safely and effectively be performed by the average nonmedical person without direct supervision of a licensed nurse, the service cannot be regarded as a skilled nursing service. (iii) The fact that a skilled nursing service can be or is taught to the beneficiary or to the beneficiary's family or friends does not negate the skilled aspect of the service when performed by the nurse. (iv) If the service could be performed by the average nonmedical person, the absence of a competent person to perform it does not cause it to be a skilled nursing service. (2) The skilled nursing care must be provided on a part-time or intermittent basis. (3) The skilled nursing services must be reasonable and necessary for the treatment of the illness or injury. (i) To be considered reasonable and necessary, the services must be consistent with the nature and severity of the beneficiary's illness or injury, his or her particular medical needs, and accepted standards of medical and nursing practice. (ii) The skilled nursing care provided to the beneficiary must be reasonable within the context of the beneficiary's condition. (iii) The determination of whether skilled nursing care is reasonable and necessary must be based solely upon the beneficiary's unique condition and individual needs, without regard to whether the illness or injury is acute, chronic, terminal, or expected to last a long time.