MSSP SNF 3-Day Rule and Waiver for ACO Providers

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If you need help determining whether your Medicare beneficiary meets the requirements for the SNF 3-Day Rule Waiver, please call 858-678-6085.

Skilled nursing facility admissions

If your hospitalized Medicare patient will need skilled nursing care or rehabilitation services after discharge, you may recommend their transfer to a local skilled nursing facility (SNF).

Scripps ACO network includes more than a dozen preferred, independent SNFs throughout San Diego County. All are staffed by full-time Scripps physicians and case managers.

Additionally, under certain circumstances, Scripps ACO providers may waive the SNF 3-Day Rule for eligible Medicare patients. Learn more about the SNF 3-Day Rule, and when it’s appropriate to use the waiver.

Overview of the SNF 3-Day Rule

Ordinarily, Medicare requires patients to receive at least three consecutive days (3 midnights) of hospital inpatient care before it will cover their stay in a SNF. This is commonly referred to as the 3-Day Rule.

Any length of time spent in the hospital as an outpatient — including emergency department care or observation services — doesn’t count toward a patient’s 3-day requirement. This is an important distinction. Patients admitted to a SNF without first receiving 72 hours of inpatient hospital care must generally pay out-of-pocket for the full costs of their stay.

However, CMS now allows some Medicare Shared Savings Program (MSSP) participants to waive the 3-Day Rule for their assigned beneficiaries.

See skilled nursing facilities in the Scripps Preferred Network below.

The SNF 3-Day Rule Waiver

Through the MSSP, CMS rewards participating ACOs that meet its cost and quality targets. On the cost side, ACOs must control or lower Medicare fee-for-service expenditures — including inpatient hospital and SNF care covered by Medicare Part A.

Thanks to a provision in the Affordable Care Act, CMS may waive specific regulations that hinder ACOs in meeting their MSSP requirements. To that end, CMS is helping certain ACOs decrease costs by waiving the SNF 3-Day Rule.

Eligible beneficiaries must meet several requirements. Specifically, they must:

Be prospectively assigned to the ACO for the performance year in which he/she is admitted to the eligible SNF
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 certain and confirmed diagnoses
Have an identified skilled nursing or rehabilitation need that cannot be provided as an outpatient; and
Have been evaluated and approved for admission to the SNF within 3 days prior to the SNF admission by an ACO provider/supplier who is a physician, consistent with the ACO’s beneficiary evaluation and admission plan.

Scripps ACO’s network includes more than a dozen eligible SNF waiver facilities throughout San Diego County.

Skilled nursing facilities in the Scripps Preferred Network

For information about SNF locations, see below or refer to this document (PDF, 880 KB). The following SNFs meet the high quality and safety standards required by Scripps and CMS: