Clarification of Skilled Nursing and Intermediate Care Facilities Services

September 3, 2019

Code of Federal Regulations (CFR), Title 42, Section 440.155(a)(1) defines nursing facility services as those provided in a facility that “fully meets the requirements for a State license to provide, on a regular basis, health-related services to individuals who do not require hospital care, but whose mental or physical condition requires services that – (i) are above the level of room and board; and (ii) can be made available only through institutional facilities.”

Under federal law, there is no distinction between a Skilled Nursing Facility (SNF), referred to as a Nursing Facility Level B (NF-B), and an Intermediate Care Facility (ICF), referred to as a Nursing Facility Level A (NF-A). Ultimately, federal law allows continuity of care protections for individuals to receive medically necessary intermediate care services at the NF-B where they are receiving medically necessary skilled nursing services. If a Medi-Cal recipient needs NF-A care, the recipient should be allowed to remain at the facility until intermediate care services are no longer needed or transfer to another care setting is selected by the recipient that is appropriate for their medical condition.