Amid Confusion, the SNF 3-Day Waiver Remains Intact Nationally

As some states begin to reopen, others are seeing increasing numbers of COVID-19 cases with hospitals reporting rising ICU utilization and near-capacity conditions. But one thing has not changed throughout the pandemic, the question of when a skilled nursing facility (SNF) or swing bed may accept a patient Part A skilled care without a preceding inpatient admission of at least 3 days.

“From the beginning of the pandemic, hospitals have been told by SNFs that the waiver is only applicable if the hospital has been directly affected by COVID-19,” reports Ronald Hirsch, MD. “Some SNFs even want the hospital to document in the chart that the transfer to a SNF was done to create bed capacity due to an overwhelming number of COVID-19 cases. That is not correct.”

The waiver was issued as a nationwide waiver that applies to every SNF and swing bed in the country with no specific qualifications on its use. The wording of the waiver does refer to “those people who experience dislocations, or are otherwise affected by COVID-19” but “otherwise affected” is a broad brush that includes any measures taken by the hospital or SNF to protect patients from COVID-19, including asking screening questions, performing swab tests, or even use of personal protective equipment by personnel.

To clarify this, Dr. Hirsch contacted the Centers for Medicare & Medicaid Services (CMS) and asked. Here is an excerpt from that correspondence:

Question: Does the section 1812(f) waiver for the 3-day qualifying hospital stay apply only to those beneficiaries who are actually diagnosed with COVID-19, or does the waiver apply to all SNF-level beneficiaries under Medicare Part A?

 Answer: The qualifying hospital stay waiver applies to all SNF-level beneficiaries under Medicare Part A, regardless of whether the care the beneficiary requires has a direct relationship to COVID-19.

“I would hope this answer, sent to me by CMS on June 26, would make it clear that the 3-day waiver continues to apply to every SNF and swing bed in the country,” added Hirsch. RACmonitor has heard some reports of SNF claims without 3-day stays being denied but Hirsch notes, “If that is the case, either the claim did not have the DR condition code properly applied or the Medicare Administrative Contractor did not process the claim correctly. A phone call to the MAC should be able to sort it out.”

Finally, Dr. Hirsch did note that last week CMS announced that one waiver that applies to SNFs was ending. “They are ending the waiver of reporting the SNF staffing data. This is a specific provision in the waivers and does not at all affect the waiver of the 3-day stay requirement.”

“Let me add that CMS made it clear in their email that they are assessing all waivers on an ongoing basis,” Hirsch said. “We have no idea how long the 3-day waver will last. But when they announced the SNF staffing data waiver cancellation, they sent out notices through all their email lists, so it will not be a secret when the 3-day waiver ends.”

Hirsch cautioned that until that time, every SNF and every swing bed in the country can accept a Medicare beneficiary who has skilled needs under part A regardless of the presence or absence of a preceding 3-day inpatient admission.

And readers can count on RACmonitor to keep them informed.

Programming Note: Dr. Ronald Hirsch is a permanent panelist on Monitor Monday, and you can listen to his live reports as he makes his Monday Rounds on the long-running broadcast, 10-10:30 a.m. EST.