CMS Pub. 100-02, ch. 7, § 50.7.2

A3-3119.7.D, HHA-206.7.D

Additional care covered by other payers discussed in §50.7.1 does not affect Medicare

coverage when the conditions listed below apply. A patient must meet the criteria for

Medicare coverage of home health services, before this policy revision becomes

applicable to skilled nursing services and/or home health aide services. The definition of

"intermittent" with respect to the need for skilled nursing care where the patient qualifies

for coverage based on the need for "skilled nursing care on an intermittent basis" remains

unchanged. Specifically:

1. This policy revision always applies to home health aide services when the patient

qualifies for coverage;

2. This policy revision applies to skilled nursing care only when the patient needs

physical therapy or speech-language pathology services or continued occupational

therapy, and also needs skilled nursing care; and

3. If the patient needs skilled nursing care but does not need physical therapy or

speech-language pathology services or occupational therapy, the patient must still

meet the longstanding and unchanged definition of "intermittent" skilled nursing

care in order to qualify for coverage of any home health services.