1135 Waiver, National Blanket Waiver – 3-Day Stay Explainer

Members | March 22, 2020 | by Janine Finck-Boyle

CMS is waiving the requirement at Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a SNF stay. 

CMS is waiving the requirement at Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a SNF stay.  This provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be admitted as a result of the effect of the disaster or emergency.

Key points:

  • The waiver is a blanket waiver for the nation, which means that a state does not need to apply for a separate waiver for 3-day stay.  The waiver applies to all states and all SNF providers.
  • The waiver allows Medicare to pay for SNF care without a 3-day inpatient hospital stay for beneficiaries who experience dislocations or are otherwise affected by the emergency, such as those who are:
    • Are evacuated frm a nursing home in the emergency area,
    • Are discharged frm a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or
    • Need SNF care as a result f the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency.  
  • The individual who is admitted does not have to have or be suspected of having COVID-19 infection.
  • The admitting SNF does not need to be located in the emergency area.
  • There are no limitations to the place of admissions to the SNF.  Admissions can come from:
    • A hospital with less than a three day stay including the E.R and OBS stay
    • The cmmunity (i.e. a physician’s office)
    • A nursing hme with a change of clinical care or need
    • Home health service or community outpatient care
    • The same nursing hme a resident is currently residing
  • The waiver is retroactive to March 1, 2020.
  • The end date is not stated.  The waiver will be rescinded when the national state of emergency is rescinded.
  • For billing on the UB-04 claim, a SNF should report code “DR” (disaster related) on their claim.  With the code added, Medicare will bypass the 3-day stay requirement and occurrence span code “70” (qualifying stay dates) need not be reported.
  • Providers should include remarks on the claim indicating “declared emergency/disaster”.  Add the remarks to the page for tracking and verification purposes.
  • It should be noted that Medicare Advantage(MA) plan and Special Needs Plan bene have always had, and continue to have, the option to waive the 3-day stay. However, they are not required to waive a 3-day stay. LeadingAge would advise members to check with their plans to see if they are waiving the 3-day stay both for individual cases and/or if they have adopted a temporary policy to waive it across the board during the national emergency.

LeadingAge has asked CMS for details on the 3-day stay as we know there are specific concerns and challenges individual members have identified.  If members have questions, please contact Jodi Eyigor or Janine Finck-Boyle (jeyigor@leadingage.org, jfinck-boyle@leadingage.org).  We will share updates as more information becomes available.