Additional Updates to SNF COVID-19 Waivers from CMS
On June 26, 2020 CMS released additional details on the use of waivers in Skilled Nursing Facilities and provided clarification on the Qualifying Hospital Stay and Benefit Period Waivers. Below is a summary of the requirements as well as additional resources to learn more.
Qualifying Hospital Stay Waiver
All Medicare A beneficiaries qualify.
The beneficiary’s status of being “affected by the emergency” exists nationwide under the current public health emergency (PHE). You do not need to verify individual cases.
Benefit Period Waiver
To qualify, it must be demonstrated that a beneficiary’s continued receipt of skilled care in the Skilled Nursing Facility is in some way related to the PHE. (Ex: A beneficiary develops COVID-19 or indirectly where disruptions from the PHE cause delays in obtaining treatment for another condition).
Does not apply to beneficiaries receiving ongoing skilled care in the facility that is unrelated to the emergency.
Determination: Is the beneficiary receiving the very same course of treatment as if the emergency had never occurred? Compare the course of treatment that the beneficiary has actually received to what would have been delivered if not in the PHE. Unless the two are exactly the same, the provider would determine that the treatment has been affected by – and therefore, is related to – the emergency.
Detailed billing instructions and information on how this affects claims processing and SNF patient assessments can be found in the MLN Matters article titled, “Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)”, article number SE20011. To view the full article and updated information, click here.
For even more insights about utilizing these two waivers, click below to view our recent webinar (presented on 6/23/2020) on Accurate Reimbursement During COVID-19 presented with Tammy Cassidy of T.L. Cassidy and Associates.