VA hospital stays count toward Medicare skilled nursing coverage eligibility, CMS confirms

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A stay in a Department of Veterans Affairs hospital that is not Medicare certified in most cases can qualify an individual for Medicare coverage of subsequent skilled nursing services, the Centers for Medicare & Medicaid Services has clarified.

CMS addressed the issue in an Open Door Forum call Thursday and in an accompanying memorandum.

A three-day hospital inpatient stay is needed to qualify for SNF coverage under Medicare. A beneficiary can meet this eligibility requirement by staying in a VA hospital, as long as it meets Medicare's definition of an emergency hospital.

To meet the emergency hospital definition, the hospital must meet certain hours of service, nurse staffing, and state or local licensing requirements. These requirements are “minimal” and should "hopefully apply" to any VA hospital, according to an official who spoke on the Open Door Forum call.

The call addressed a variety of topics, including timelines for phasing out use of the Minimum Data Set 2.0, as well as the recently issued final rule for 2014 SNF Medicare payment rates.

An encore of the call will be available starting Monday. Information for accessing the encore is available here.

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