Section 16.03.10.225 - NURSING FACILITY: COVERAGE AND LIMITATIONSAn institution must provide, on a regular basis, health-related care and services to individuals; who because of their mental or physical condition require care and services above the level of room, board, and supervision.
01.Nursing Facility Care. The minimum content of care and services for nursing facility patients must include the following: b. Bed and bathroom linens;c. Nursing care, including special feeding if needed;e. Supervision as required by the nature of the patient's illness and duration of their stay in the nursing facility;f. Special diets as prescribed by a patient's physician;g. All common medicine chest supplies that are over-the-counter including mouthwashes, analgesics, laxatives, emollients, burn ointments, first aid cream, protective creams and liquids, cough and cold preparations, and simple eye preparations;i. Administration of intravenous, subcutaneous, or intramuscular injections and infusions, enemas, catheters, bladder irrigations, and oxygen;j. Application or administration of all drugs;k. All medical supplies including gauzes, bandages, tapes, compresses, cottons, sponges, hot water bags, ice bags, disposable syringes, thermometers, cellucotton, incontinent supplies, or any other type of pads used to save labor or linen, and disposable gloves;l. Social and recreational activities; andm. Each item that is utilized by individual patients and is reusable and expected to be available, such as bed rails, canes, crutches, walkers, wheel chairs, traction equipment, and other durable medical equipment.02.Skilled Services. Skilled services include services that could qualify as either skilled nursing or skilled rehabilitative services, that include: a. Overall management and evaluation of the care plan. The development, management, and evaluation of a resident's care plan, based on the physician's orders, constitute skilled services when, in terms of the patient's physical or mental condition, such development, management, and evaluation necessitate the involvement of technical or professional personnel to meet their needs, promote their recovery, and assure their medical safety. This would include the management of a plan involving only a variety of personal care services where, in light of the patient's condition, the aggregate of such services necessitates the involvement of technical or professional personnel. Where the patient's overall condition would support a finding that their recovery and safety could be assured only if the total care they require is planned, managed, and evaluated by technical or professional personnel, it would be appropriate to infer that skilled services are being provided.b. Observation and assessment of the resident's changing condition. When the resident's condition is such that the skills of a licensed nurse or other technical or professional person are required to identify and evaluate the patient's need for possible modification of treatment and the initiation of additional medical procedures until their condition is stabilized, such services constitute skilled services.03.Direct Skilled Nursing Services. Direct skilled nursing services include the following:a. Intravenous injections; intravenous feedings; intramuscular or subcutaneous injection required on more than one (1) shift;b. Nasopharyngeal feedings;c. Nasopharyngeal and tracheotomy aspiration;d. Insertion and sterile irrigation and replacement of catheters;e. Application of dressings involving prescription medications or aseptic techniques;f. Treatment of extensive decubitus ulcers or other widespread skin disorders;g. Heat treatments that have been specifically ordered by a physician as part of treatment and that require observation by nurses to adequately evaluate the resident's progress; andh. Initial phases of a regimen involving administration of oxygen.04.Direct Skilled Rehabilitative Services. Direct skilled rehabilitative services include the following: a. Ongoing assessment of rehabilitation needs and potential, services concurrent with the management of a resident's care plan, including tests and measurements of range of motion, strength, balance, coordination, endurance, functional ability, activities of daily living, perceptual deficits, speech and language or hearing disorders;b. Therapeutic exercises or activities that, because of the type of exercises employed or the condition of the resident, must be performed by or under the supervision of a qualified physical therapist or occupational therapist to ensure the safety of the resident and the effectiveness of the treatment;c. Gait evaluation and training furnished by a physical or occupational therapist to restore function in a resident whose ability to walk has been impaired by neurological, muscular, or skeletal abnormality; andd. Ultrasound, short-wave, and microwave therapy treatments by a licensed physical therapist.05.Other Treatment and Modalities. Other treatment and modalities that include hot pack, hydroculator, infrared treatments, paraffin baths, and whirlpool, in cases where the resident's condition is complicated by circulatory deficiency, areas of desensitization, open wounds, fractures, or other complications, and the skills, knowledge, and judgement of a licensed physical therapist are required.Idaho Admin. Code r. 16.03.10.225