Providers must demonstrate that a beneficiary’s skilled nursing care in a facility is “in some way” related to the coronavirus public health crisis in order to qualify for the three-day inpatient qualifying hospital stay waiver benefit, the Centers for Medicare & Medicaid Services is emphasizing.
The agency released updated guidance on the SNF benefit period waiver for providers on Friday. The guidance also explains that the benefit waiver period would not apply to beneficiaries that receive ongoing care in the SNF that is “unrelated to the emergency.”
“For example, 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,” the agency explained in an MLN Matters article. It added that in that situation would fall under continued skilled care in the SNF “rather than the emergency that is preventing the beneficiary from beginning the 60 day ‘wellness period.’”
CMS explained that when making determinations, a SNF resident’s ongoing skilled care is considered to be emergency-related unless it is altogether unaffected by the COVID-19 emergency itself.
“This determination basically involves comparing the course of treatment that the beneficiary has actually received to what would have been furnished absent the emergency. Unless the two are exactly the same, the provider would determine that the treatment has been affected by — and, therefore, is related to — the emergency,” CMS wrote.
The updated guidance also provides billing instructions for providers using the three-day state and benefit period waivers.