Medicare Part A covers post-hospitalization, subacute skilled care and rehabilitation benefits for individuals who were admitted to the hospital and remained as inpatients for at least three overnights. Upon discharge to a subacute facility with a need for ongoing skilled nursing or rehabilitative services, Medicare would cover up to 100 days of treatment including the room & board costs, subject to co-payments and deductibles. In other posts, we have written about some of the issues that would come up for patients receiving such benefits.
In light of the exigencies caused by COVID-19 and the urgent need to transfer patients from hospitals to subacute rehabilitation facilities, Medicare has waived the three-overnight requirement for people in the hospital to get to subacute rehab. There have been demonstration projects around the country for several years involving waivers of the 3-day stay requirement. Medicare 3 day waiver. The March 13th announcement by the CMS Administrator specifies that ” Therefore, SNF care without a 3-day inpatient hospital stay will be covered for beneficiaries who experience dislocations or are otherwise affected by the emergency, such as those who are (1) evacuated from a nursing home in the emergency area, (2) discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or (3) need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency. In addition, we will recognize special circumstances for certain beneficiaries who, prior to the current emergency, had either begun or were ready to begin the process of ending their spell of illness after utilizing all of their available SNF benefit days.” CMS’ 2020 SNF secn 1812f waiver
The patient and their advocate will need to be proactive as always in working with the physician and the SNF assessing staff to develop a treatment plan that provides the fullest possible range of services to meet the needs of the patients. Keep in mind that “failure to progress” is not the sole criteria for continued Medicare coverage for subacute care. However there is an increasing trend by Medicare insurance intermediaries to pressure the facilities to terminate coverage after just a few weeks. What do advocates need to do? Be vigilant, be vocal, be aware. Make sure that the patient you are assisting has signed HIPPA releases to enable you to access their protected health information and talk with the personnel on the team. Be vigilant, be vocal, be there.