Geriatrics

SKILLED NURSING FACILITY CARE (SNF)

Where provided:  

• Nursing homes that are Medicare certified SNF's

Qualifiers:

• Hospital Inpatient 3 nights
• Moderately complex medical problem

What constitutes moderately complex care?
Examples:

• IV's, IM injections
• Feeding tubes
• Dressing changes (usually more than simple)
• Restorative care (care and teaching by licensed nurse) (e.g. care & training on: ostomy care, feeding tube care, wound care, etc.
• Rehabilitation

Who decides eligibility?

The receiving SNF determines eligibility for Medicare benefits and assumes the financial responsibility if they determine the benefits incorrectly.

Medicare pays for:
100 days (the first 20 days Medicare pays 100%, the next 80 days pays 80%)
Note: 100 days of benefit is renewed when the resident has not been in a hospital or SNF for 60 days in a row and has now re-entered a hospital for 3 nights in a row.

Also: The patient can elect to use the benefit anytime within 30 days of  being in an acute care hospital for 3 nights (e.g. if they went home from hospital and they are finding they need more care,  they can directly enter a SNF if within 30 days of hospital discharge.  

What must a SNF provide?

Services SNF must provide: (required)  

• Rehabilitation services (OT/PT/Speech)
• 24 hour skilled nursing services

How often is the patient seen by a physician or midlevel provider at a SNF?

• Physician first visit within 30 days of admission
• Physician/Mid-level alternate every 30 days x 3 then every 60 days