in section 1905(a)(13) of such Act ( 42 U.S.C. 1396d(a)(13) ). (G) Such other services specified by the Secretary. (7) Institutional setting The term institutional setting means— (A) a skilled nursing facility (as defined in section 1819(a) of the Social Security Act ( 42 U.S.C. 1395i–3(a) ))