Skilled Nursing Homes 3-Day Rule

The House re-introduced a bill last month seeking to rescind a long-standing Medicare provision that restricts beneficiaries from receiving rehabilitation services in skilled nursing facilities (SNFs).

The bill is called the Creating Access to Rehabilitation for Every Senior Act (H.R. 4701), or the CARES Act of 2017. It would eliminate Medicare’s current prior three-day hospitalization requirement for subsequent coverage for skilled nursing care.

The bill is sponsored by Rep. James Renacci, an Ohio Republican. The CARES Act was originally introduced in the House in 2015 during the 114th Congress; however, it was not passed.

What Is The Current 3-Day Hospital Stay?

Medicare patients are eligible for inpatient skilled nursing care only when they have been first admitted to the hospital as an inpatient for three consecutive days. This, according to the Centers for Medicare and Medicaid Services (CMS).

This provision is commonly known as the SNF three-day rule., or ‘Qualifying Hospital Stay ‘ (QHS) . In addition, Medicare only covers up to 100 days of skilled nursing facility care per episode of care. Payment is made after the patient can show proof of their qualifying three-day inpatient hospital stay.

Furthermore, observation nights don’t count toward the three-day requirement, and are not covered by Medicare.  This causes confusion and anger among patients who later find that their care is not covered.

The 3-day rule angers skilled nursing practitioners, as organizations such as AARP and the American Health Care Association lobby for its removal. In addition, the SNF’s object to the observation stays, in which patients stay overnight in hospitals for observation without ever being formally admitted.

What The Care Act Rescind  Does

Eliminating the 3-day required hospital stay will speed up seniors receiving acute care in skilled nursing facilities. These patients are typically the oldest and frailest of the Medicare population and immediate access to acute health services is critical.

A Word of Caution

In my own experience as Admissions Director at our post-acute rehab facility, Regency Park Nursing and Rehabilitation, in Hazlet, NJ, I recall instances where patients who spent at least several days at the local Bayshore Community Hospital, were under the mistaken impression that they had achieved a qualifying hospital stay for in-patient rehabilitation, when in reality, they were listed under observation only.

Check your hospital records and ask questions so that you have the proper clarity before making important decisions related to your health and well being.

About Judah Gutwein, L.N.H.A.

As a Licensed Nursing Home Administrator, with additional years of experience as an Admissions and Marketing Director, I am intimately familiar with the challenges of building and maintaining a vibrant census in nursing and rehab facilities. Regency Nursing Centers has a well deserved reputation for excellence in healthcare and I'm extremely proud of our achievements! Thanks for reading our Regency Blog!
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