Current through Register Vol. 44, No. 18, September 25, 2021
Skilled nursing services in a licensed nursing care facility are those services
licensed nursing personnel, or personnel under their
supervision. These services must be performed according to a plan of treatment
written by a physician licensed to practice medicine in the State of Colorado.
These services apply to clients whose condition(s) require medical services to
maintain a degree of stability, which has been achieved. Components of these
1. The medical need
for the attending physician to visit the client on a professional basis at
least once every thirty (30) days.
2. Observation and assessment of the total
needs of the client, utilizing skilled nursing judgment.
3. Planning, organizing, and managing the
client care plan which requires specialized training to accomplish delivery of
health care, or to attain the desired results or to render direct services to
health care services require regular medical care and 24-hour licensed nursing
services for illnesses, injury, or disability. Nursing service shall be
organized and maintained to provide 24hour licensed nursing services under the
direction of a registered professional nurse employed full time and at least
two (2) hours total nursing staff time for each patient per 24-hour
Covered skilled nursing
services must adhere to one or more of the following principles:
1. A service which requires a substantial
specialized judgment and skill based on knowledge and application of the
principles of biological, physical, and social sciences, necessary to perform
or supervise effectively the services rendered, or
2. A service that is unskilled but which
requires skilled performance, supervision, or observation because of special
medical complications. Medical complications and special services must be
documented by the physician's order and the nursing notes.
In addition to meeting the definition of
skilled nursing services, coverage of such services is warranted only if
skilled nursing personnel must be available on a continuous 24-hour basis. In
determining whether the continuous availability of such personnel is warranted,
the following principles apply:
of Services - The frequency of skilled nursing services required, rather than
their regularity, is the controlling factor in determining whether the
continuous availability of skilled nursing personnel is warranted.
Where observation is the principle continuous service provided, because
symptoms exist that indicate the need for immediate modification of treatment
of institution of medical procedures.
E. The purpose of the above-stated components
and principles, and of 10 CCR 2505 -10 section 8.408.1 et seq., is to provide
general direction and guidelines for admission, utilization review, and medical
review; with the intent that the individual's overall medical situation
(including mental condition) shall be taken into account in evaluation and
determination of the level of care to be provided.