Displaying items by tag: rehabilitation

In April, 2020, Executive Order 2020-50 (EO 2020-50) established Regional Hubs to care for COVID-19 residents discharging from a hospital or transferring from a nursing facility (NF) if the originating facility was not equipped to care for the resident.

The bulletin is addressed to Medicaid-certified Nursing Facilities including: Assisted Living Facilities, Adult Foster Care Homes, Homes for the Aged. It identifies "Minimum Participation Criteria" for each type of facility. It also outlines standards that each seleced CRC must meet to participate.

In circumstances when an individual meets Medicaid NF level of care, MDHHS will consider CRC admissions from other long-term care facilities, assisted living facilities, homes for the aged, and adult foster care homes on a case-by-case basis.
You can read and print out the entire bulletin at Bulletin Number:MSA 20-72

I was on the forums these past few days and one of the threads was talking about how many days are covered by Medicare in a Nursing Home or Rehab after a hospital stay. The answers were all over the map and quite confusing I must confess, so I thought I would do a post about it to clear things up. I have always told my readers I am no expert, but when it comes to this subject I know it all to well. You see my mom has been in and out of rehab 3 times in the past 2 years so we know the rules by heart.

According to Medicare rules a person must have a qualifying hospital stay of at least 3 days, ( 24 hours) and be in need of further skilled nursing or rehab care in order for them to pay for the stay. The doctor and the physical therapy department at the hospital must agree that the patient would benefit from continued care or therapy at a nursing home or rehab facility. 

It is important to note at this point that the patient needs to be an inpatient at the hospital for 3 days, and time spent in observation or the ER does not count. They have to be admitted to the hospital. This is very important!

Insurance companies and Medicare are putting increased pressure on doctors so that they do not admit patients. They have narrowed the guidelines for admittance and now many patients are ending up in observation for 1, 2 or 3 nights and then they do not qualify to go to rehab under Medicare. 

If a person has a qualifying stay of 3 days then Medicare will pay for nursing home or rehab as follows:

1. Day 1-20 Covered 100%
2. Day 21-100 partial coverage with a 161.00 a day co-pay
3. Day 101 and beyond no coverage

Many Medicare supplement policies like the one my mother has will cover the copay on days 21-100 so there is no out of pocket for the patient. However this is something you should look into ahead of time so you know your coverage should you or a loved one be in this situation. 

During the time in rehab the patient must continue to show that the services provided are helping them to improve. So if at anytime during their stay the team feels they have done all they can for the patient the team is obligated to discharge them, even if they have days left.

Now there is something to be said about having days left over. If the patient leaves rehab or nursing care and they need to be readmitted to the facility within 30 days and have days remaining they will have coverage through Medicare. If they use up all their days then they would have to wait 60 days and have another qualifying hospital stay of 3 days before Medicare would pay for skilled nursing care or rehab again. This would start their 100 day benefit period over again. 

I am providing a link here that goes to the Medicare.gov site for skilled nursing care. It has more information for you. 

I do hope this information helps you understand the process a bit better. If you have any questions or comments please feel free to contact me or leave a comment at the bottom. We always love to hear from you. Remember you are not on this journey alone.