When a resident's skilled care services end, but within 30 days, the resident's condition worsens and is determined by the clinical team that their level of care meets clinical requirements for daily skilled care, the resident will be able to re-access the remainder of their 100-day benefit without requiring a 3-day qualifying hospital stay.

The skilled care must address either:

• A hospital-related medical condition.
• A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition.

Who may be eligible for the 30-Day Window of Medicare coverage? (20.2.3 - Readmission to a SNF)

• Patients discharged from the hospital to the community after having a qualifying stay.
• Patients discharged from a skilled nursing facility to the community.
• Patients cut from Medicare at a skilled nursing facility.

"If an individual, who is receiving covered post-hospital extended care, leaves a SNF and is readmitted to the same or any other participating SNF for further covered care within 30 days after the day of discharge, the 30-day transfer requirement is considered to be met." The same is true if the beneficiary remains in the SNF to receive custodial care following a covered stay and subsequently develops a renewed need for covered care there within 30 consecutive days after the first day of noncoverage​​.

What happens when a resident is beyond the 30 days window, but does not have a 60-day wellness period?

• The resident will need a new three-day qualifying hospital stay to be able to access the remainder of their 100-day benefit.
• This will stop the clock on the 60-day spell of wellness.

Questions:

• Does an emergency room visit without an admission to the hospital affect the 60-day spell of wellness count or allow a resident to access the remainder of the 100-day benefit?

This information outlines the conditions under which a patient can re-access their Medicare SNF coverage within the 30-day window, as well as the implications for those who are beyond this window without a qualifying hospital stay