Subject to various exceptions, a covered skilled nursing facility (“SNF”) stay must initiate within 30 days of a qualifying hospital stay. In some cases where it is medically predictable that an individual will require a covered level of SNF care within a determinable time frame, that same individual may also have a need for a covered level of SNF care within 30 days of their hospital discharge. This is referred to as “deferred covered treatment” and does not negate further coverage at a future date, even if there is a non-covered interval of more than 30 days between the two stays.
Effective June 15, 2015, CMS has updated the Medicare Benefit Policy Manual to include two additional deferred covered treatment situations.
The first involves an individual receiving covered post-hospital extended care in a SNF and then leaves. So long as the individual is readmitted to the same or any other SNF for further covered care within 30 days of the last covered skilled day, the 30-day transfer requirement is considered to be satisfied.
The second situation is when an individual is receiving covered SNF care but then remains in the SNF to receive custodial care. If the individual subsequently develops a renewed need for covered care within 30 days, the 30-day transfer requirement will be satisfied.
Should you have any questions, please contact:
- Todd Selby at (317) 977-1440 or tselby@hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- David Bufford at (502) 568-9368 or dbufford@hallrender.com; or
- Your regular Hall Render attorney.
