Archived Article: SNF - Skilled Nursing Facility Coverage For Medicare+Choice Beneficiaries Without A Three Day Hospital Stay (Copyright, Center for Medicare Advocacy)

MEDICARE COVERAGE FOR SKILLED NURSING FACILITY
STAY FOR TERMINATED MEDICARE+CHOICE
BENEFICIARIES WHO LACK A QUALIFYING
THREE DAY HOSPITAL STAY

The Health Care Financing Administration (HCFA) has issued a program memorandum advising Medicare Intermediaries to pay for skilled nursing facility (SNF)coverage for SNF residents involuntarily disenrolled from their Medicare+Choice organization as a result of the M+C's termination, regardless of whether there has been a three-day prior hospitalization.. Transmittal A-00-26, HCFA-Pub. 60A (May 2000). The policy reflects the fact that some M+C plans provide SNF coverage without the three day hospital stay required under original Medicare and that terminated M+C beneficiaries would not, therefore, be aware of any such qualification to be eligible for coverage.

The memorandum directs intermediaries to starting counting the 100 days of SNF coverage with the date of SNF admission, regardless of whether the beneficiary met the skilled nursing or rehabilitation level of care requirement on that date. This policy is effective as of January 1, 2000, until further notice. The memorandum is available at http://www.hcfa.gov/pubforms/transmit/memos/comm_date_dsc.htm.