Page 103 - CHHA Binder 2.3.20

4/11/2019

Skilled Need

 Requires the skill of an RN, PT, OT or ST
o VNSNY protocol more limiting: only RN or PT can be Coordinator of
Care/Case Manager
o OT can close a case if it is the last service out

 Education, training, and expertise of these professionals
needed to implement care
o Primary VNSNY disciplines: RN & PT
o Secondary VNSNY disciplines: ST, MSW, OT, HHA
o Custodial care is NOT skilled

 A service is not skilled merely because a nurse
performs it.

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Medically Reasonable & Necessary

 Care is consistent with nature and severity of illness/injury

 Care follows accepted standards of medical practice

 Maintenance therapy is covered only under special
circumstances

 Physician-generated orders

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