A health service is determined to be skilled based upon whether or not clinical training is necessary for the service to be delivered safely and effectively and on the need for physician-directed medical care. Examples of individuals with clinical training include a registered nurse, licensed practical nurse, respiratory therapist, physical therapist, occupational therapist, and speech therapist. This list is not all-inclusive. Services provided by a certified nursing assistant or home health aide do not qualify as skilled care services.
The absence of a caregiver to perform a service does not cause a non-skilled service (i.e. Custodial Care) to become a skilled service. For example, the mere fact that the care is received by virtue of the fact that: (1) the patient is unable to perform an activity independently; (2) based only on the request of the patient or a family member; or (3) a clinically trained family member has been performing the activity for the patient, does not cause unskilled care to be reclassified as skilled. Whether or not care is skilled or not is determined by the intrinsic nature of the service and the need for physician-supervised management.