Skilled Nursing Facility (SNF) 3 Day Waiver Overview
Beginning July 1, 2019 Beaumont ACO through its participation in Medicare Shared Savings Program (MSSP) Enhanced Track will be eligible to utilize the SNF 3 Day Waiver Program. Only Shared Savings Program ACOs that are currently participating in, or applying to, certain Shared Savings Program performance based risk tracks have the opportunity to apply for a waiver of the SNF 3-Day Rule.
The SNF 3-Day Rule Waiver waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries. To be eligible to receive covered SNF services under the waiver, a beneficiary must appear on an eligible Assignment List Report:
Additionally, beneficiaries must meet the following requirements:
- Not reside in a SNF or other long-term care setting
- Be medically stable
- Not require inpatient or further inpatient hospital evaluation or treatment
- Have an identified skilled nursing or rehabilitation need that he/she cannot receive as an outpatient
- Have been evaluated and approved for admission to the SNF within 3 days prior to the SNF admission by an ACO provider/supplier that is a physician, consistent with the ACO's beneficiary evaluation and admission plan.
Eligible beneficiaries will be referred to affiliated SNFs which have contracted with Beaumont ACO to participate in the SNF 3 Day Waiver program.
The referral for SNF 3 Day waiver admission can be received from outpatient ACO physicians, Emergency Departments, Observation/ Short Stay, and Inpatient Acute Care settings. The requesting entity can contact the ACO Care Coordinator on call 248-551-5561, pager # 226763 to assist in the review of eligibly and direction on the process to admit under the SNF 3day waiver program. Please review the work flow embedded in this document: Exhibit A SNF 3 Day Waiver Flow Chart(pdf)
All eligible patients must receive the form Eligible Medicare patients Can Receive Skilled Nursing and Rehabilitation Care without a 3-Day Prior Hospital Stay at Eligible SNFs. Exhibit B 2019 3-Day SNF Waiver Notice (docx)
Once a patient has been reviewed and is eligible for the SNF 3day waiver they are to review the list of contacted Skilled Nursing Facilities to select a placement facility. Exhibit C Beaumont ACO Affiliated SNF for 3-Day Waiver (pdf)
The Beaumont ACO 3 Day Waiver Program SNF Admission Orders and Care Management Plan form is complete and sent with the patient to the accepting contracted SNF facility. Exhibit D SNF Admission Orders and Care Management Plan Form (pdf)