Skilled Nursing Facilities « Elder Care
Articles Related to Skilled Nursing Facilities
Who's Responsible for Care After Stroke? (Post-Gazette Now – 3/31/09)
With certain limitations and so long as the therapy meets the "reasonable and necessary" test, Medicare will generally pay for PT, OT and ST in the hospital, in a skilled nursing facility for up to 100 days, in the home setting under specific circumstances, and at special therapy facilities.
You're Not in the Hospital. You're in Observation! (CMA Health Policy Consultants – 7/13/10)
Medicare beneficiaries – although placed in hospital beds (often, from the emergency room) and given medications, tests, therapies, medical and nursing services, food, and a wrist-band – are told they aren’t in-patients; they’re just receiving observation services as outpatients. Patients often learn about their out-patient status just as they are leaving the hospital for the skilled nursing facility – which won’t be covered by the Medicare program because they weren’t in-patients for three consecutive days! For related article, see "Medicare Fraud Effort Gives Elderly Surprise Hospital Bills."
Medicare/Medicaid Benefits in Skilled Nursing Facilities
- Question: When does the "clock" get reset for Medicare benefits in a nursing home? Example: dad enters nursing home (after 3 nights in hospital) for 20 days and then goes home. Reenters nursing home 60 days later (after another 3 nights in hospital). Does the clock get reset back to 100 day max?
- Answer: From Medicare Advocacy website:
- "Medicare Part A provides payment for post-hospital care in skilled nursing facilities (SNFs) for up to 100 days during each spell of illness. A "spell of illness" begins on the first day a patient receives Medicare-covered inpatient hospital or skilled nursing facility care and ends when the patient has spent 60 consecutive days outside the institution, or remains in the institution but does not receive Medicare-coverable care for 60 consecutive days."
- Therefore, the 3 days in the hospital prior to SNF admission result in the second SNF admission's still being considerated part of the first spell of illness.
- An Overview on Medicaid Eligibility for Nursing Home Care and Payment (Helium.com)
For starters, Medicare requires that a patient spend three midnights in the hospital before being admitted to a skilled nursing facility. With the push to get people in and out of hospitals, some doctors may be reluctant to keep the patient this long, so be prepared to play hardball.
- Medicare Coverage of Skilled Nursing Facility Care – Revised Sept. 2007 (Centers for Medicare & Medicaid Services)
This official government booklet explains Medicare-covered skilled care, your rights and protections and where to get help with questions.