Skilled Nursing Facility Leveling

This policy covers reimbursement for skilled nursing facility (SNF) level-of-care placements (Levels 1–5), defining each level by required daily/hourly skilled nursing and therapy thresholds and by specific high‑acuity indications. Coverage is intended for patients with medically complex or high‑acuity needs (e.g., catastrophic trauma, severe head injury/CVA, spinal cord injury, ventilator dependence, or needing listed high‑cost drugs) and is limited to services that require qualified nursing or therapy personnel; payment is contingent on meeting the exact staffing/therapy thresholds and the facility’s contract status, and care safely provided by non‑skilled personnel is excluded.

"Reimbursement for skilled nursing facility (SNF) level of care is allowed only when the facility meets the specified level-of-care service requirements."

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