The COVID-19 pandemic has been particularly devastating for nursing homes and their residents. Aside from the tragically disproportionate loss of life, care for surviving residents has been delayed or interrupted due to infection, facility lockdowns or other health system disruptions. As a result, the Centers for Medicare & Medicaid Services (CMS) has waived two limitations on Medicare Part A skilled nursing facility (SNF) coverage during the coronavirus pandemic:

  1. The 3-day qualifying hospital stay requirement; and
  2. The 100-day benefit period.

However, CMS treats the two SNF coverage expansions differently from each other with regard to its connection to COVID-19.

Three Day Prior Inpatient Hospital Stay

The qualifying hospital stay waiver applies to all SNF-level beneficiaries under Medicare Part A, regardless of whether the care the beneficiary requires has a direct relationship to COVID-19. This means a beneficiary can get Part A coverage in an SNF whether or not the individual was a hospital inpatient for three consecutive days, or any days at all. This is true so long as the beneficiary meets all other requirements for Part A coverage (e.g., needs skilled nursing care seven days per week or skilled rehabilitation services five days per week, or a combination of the two).

100-Day SNF Coverage Limit

For expansion of the 100-day limit on SNF coverage, however, the beneficiary’s COVID-19 status is relevant. According to CMS, “If the patient has a continued skilled care need (such as a feeding tube) that is unrelated to the COVID-19 emergency, then the beneficiary cannot renew his or her SNF benefits under the waiver as it is this continued skilled care in the SNF rather than the emergency that is preventing the beneficiary from beginning the 60-day ‘wellness period’.” Thus, SNF residents can receive an additional 100 days of Part A coverage only when their continued need for care is related to the COVID pandemic.

Nursing home residents who qualify for the additional 100 days of coverage can continue to use them, even after the waiver of the benefit period ends. According to CMS, “If a beneficiary has qualified for the special one-time renewal of SNF benefits under the benefit period aspect of the waiver while the waiver is in effect, that reserve of 100 additional SNF benefit days would remain available for the beneficiary to draw upon even after the waiver itself has expired.”

Please feel free to contact our Rothkoff Law Group should you have any questions regarding skilled nursing care coverage.