What Do You Mean It's Not Covered: How the Policy Defines Health Care Facilities
Eextended care facility: An institution which is recognized as a skilled nursing facility by the state in which such institution is located; is regularly engaged in providing continuous skilled nursing care under the supervision of a graduate registered nurse for 16 hours and a graduate registered nurse or licensed practical nurse for the remaining eight hours; maintains a daily medical record of each patient; and administers a planned program of observation and treatment by a physician (other than proprietor or an employee of such facility) which is in accordance with existing standards of medical practice for the injury or sickness causing confinement. The definition of extended care facility, as herein defined, shall not include any home, facility, or part thereof used primarily for rest, for the care of the aged, drug addicts or alcoholics, or for the care and treatment of mental or nervous disorders, or educational care or any facility used exclusively for Custodial Care.
These paragraphs distinguish an extended care facility, which provides skilled nursing care, from a hospital, which provides a broader range of medical, diagnostic and surgical services. Coverage for extended care may be optional or excluded in basic medical policies (it's usually included in major medical policies). The term "extended care facility" doesn't include rest homes, old age homes, substance abuse treatment centers, facilities that treat mental illness, or facilities that exclusively provide custodial care (assistance with the tasks of daily living such as dressing, eating, bathing, etc.).
An institution which is operated according to law: is primarily engaged in providing in-patient medical care and treatment to injured or sick persons for which a charge is made; and provides or operated (either on its premises or in facilities available on a pre-arranged basis) medical, diagnostic and major surgical facilities under the supervision of a licensed physician; and provides 24 hour nursing service by or under the supervision of a graduate registered nurse. For purposes of treatment of alcoholism, a hospital shall also include an institution which is accredited by the Joint Commission on Accreditation of Hospitals; and offers medical, therapeutic and psychiatric care for the treatment of alcoholism. A special unit of a hospital or any institution which provides primarily convalescent, rehabilitative, nursing, ambulatory or extended care is not considered a hospital as defined.
