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37.40.120    PROBLEM CASES

(1) There are some situations in which a patient's condition requires the institutional services provided by a skilled care facility, but does not require the type of care which is defined as skilled care. Such situations often arise where a patient needs extensive personal services due to permanent handicap or general debility, and alternative living arrangements are impractical or impossible due to socio-economic, physical or emotional reasons.

(2) Certain emotional conditions, or disturbed patients may require continuous services of sufficient degree of skill as to be considered as skilled service. However, when such is the case the exact services and medications should be sufficiently documented to justify claiming this as a skilled service.

(3) When any of the following circumstances exist, there must be evidence that continuous skilled nursing service is also concurrently required and received. These are not of themselves considered skilled services, but in combination with others may be skilled services.

(a) The primary service is one or more of the following:

(i) oral medication;

(ii) skin care to prevent decubiti;

(iii) restraints;

(iv) frequent laboratory tests;

(v) routine incontinence care;

(vi) routine care for the blind;

(vii) supervision of daily living activities.

(b) The patient is capable of independent ambulation, dressing, feeding, and hygiene.

(c) The patient has outside privileges.

(d) The diagnosis shown is not of a type which is sufficiently specific to indicate skilled treatment regimen; i.e., the diagnosis is chronic brain syndrome, senility, arteriosclerosis, "old" CVA, etc.

History: Sec. 53-6-113, MCA; IMP, Sec. 53-6-113, MCA; NEW, Eff. 1/3/77; TRANS, from SRS, 2000 MAR p. 489.

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