Medicare-covered skilled nursing facility services, 1967-88.

The skilled nursing facility benefit under Medicare has been difficult to administer because its intent has been subject to misinterpretation. This article describes the series of legislative and administrative actions taken to align the benefit's use with its intent. Data are presented to show the changes in utilization and program expenditures in response to the actions taken. The 1988 clarifications to the level-of-care requirements seem to have resulted in an increased level of use of skilled nursing facility services.