The Centers for Medicare and Medicaid Services (“CMS”) is the federal agency that oversees the Medicare and Medicaid programs. On March 13, 2020, CMS made a number of rule changes that should help streamline the Medicare system for beneficiaries who need to access Medicare benefits during the COVID-19 outbreak. One element of the CMS rule changes will improve Medicare beneficiaries’ access to Medicare Skilled Nursing Facility (“SNF”) services.
Traditional Medicare SNF Rules
Traditionally, a Medicare beneficiary who requires skilled services in a nursing facility is only eligible for SNF services within 30 days of a three-day qualifying hospital stay. Traditional SNF benefit rules provide that skilled care may be provided during the benefit period for “up to 100 days” as long as there is a need for skilled care. The benefit period is limited to a “spell of illness” which begins on the date SNF benefits are provided and ends when the Medicare beneficiary has been out of a hospital and/or SNF inpatient setting for 60-consecutive days.
SNF Rule Changes as of March 13, 2020
There are two important changes that increase the amount of SNF benefit days available to Medicare beneficiaries. First, the requirement for a three-day qualifying hospital stay has been waived. In addition, the rules regarding the benefit period have been revised. SNF benefits may now be renewed if an individual has exhausted SNF benefits (e.g. used all 100 days of benefits) without having to meet the requirements related to starting a new benefit period (e.g. new spell of illness by being home for 60 consecutive days).
Finally, Medicare has extended deadlines for filing Medicare appeals and waived certain timelines related to processing the appeals.