When the public health emergency (PHE) ends on May 11, so will the nationwide waivers of the 3-Day Stay requirement and the Spell of Illness for skilled nursing facility (SNF) qualification that has been in effect since March 14, 2020.

• The end of this waiver means patients must have a qualifying 3-day inpatient hospital stay to obtain Medicare coverage for their skilled nursing care.
  • SNF admission teams should verify patients have the qualifying hospital stay (i.e., three midnights) and reach out to their referral partners to ensure Medicare benefit coverage for patients.
• The Spell of Illness waiver removed the break in illness requirement for a new benefit period; going forward, the rules requiring the normal break in illness (60 days) between benefit periods will be enforced. 

What you need to know: The Virginia Hospital and Healthcare Association shared with VHCA-VCAL a copy of the communication it sent to its  members on the “VHHA: Expiration of PHE Waivers Related to Nursing Home Discharges”.

• Of note, during the PHE, there were instances when a patient’s 3-day stay status was changed during coding to reflect a shorter duration inpatient stay after the nursing facility admission. While this did not affect the patient’s access to Medicare SNF benefits and coverage during the PHE, that will no longer be the case.
• While the 3-Day Stay waiver has been in effect, SNFs have been able to resubmit claims under the waiver, but after May 11, 2023, this will no longer be the case and the SNF will have no recourse on the denied claims.

Action for facilities:

• Ensure admissions staff are fully informed of the change coming with the end of the PHE and the need to verify whether a patient had a 3-day qualifying hospital stay prior to admission.
• Communicate with hospital discharge personnel and referral partners about the importance of receiving accurate inpatient stay information and dates for patients being admitted to the SNF.
• Review claims submission processes to avoid inappropriately submitting claims that do not meet the 3-day stay requirement.