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.
- 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 The waiver will be rescinded when the national state of emergency is rescinded.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 (firstname.lastname@example.org, email@example.com). We will share updates as more information becomes available.