What does the 3-Day Prior Hospitalization waiver extension mean for seniors seeking skilled nursing facility-level care?
Over the course of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services issued several waivers in response to the Public Health Emergency. These waivers were scheduled through at least January 2022. In January, it was determined that the 3-Day Prior Hospitalization waiver would remain in effect at least through April 16, 2022. This waiver allows for Medicare coverage of skilled nursing facility level of care without a qualifying hospitalization.
Under the traditional Medicare guidelines, a Medicare beneficiary must be admitted to a hospital for three consecutive nights before qualifying for continued Medicare services, including transferring to a skilled nursing community under their insurance. What does this mean for you or your loved one? This waiver may allow your loved one to avoid an inpatient hospitalization by allowing them to transition to a skilled nursing community to receive the necessary support. The patient would receive the necessary services—skilled nursing, physical, occupational, and/or speech therapies—before returning home or to a less restrictive environment when appropriate.
There are several additional factors that must be considered to meet this level of care. The patient must require skilled nursing services or skilled rehabilitation services, i.e., services that must be performed by or under the supervision of a professional. The patient also must require skilled nursing services daily, skilled rehabilitation services five days per week, or a combination of the two.
If you have any questions related to Medicare coverage and skilled nursing level of care, Rothkoff Law Group is available to assist you.