Iowa and Indiana Flooding: 3-Day Qualifying Hospital Stay - Extended Benefit Period
The Centers for Medicare & Medicaid Services (CMS) has determined that it is appropriate to provide temporary emergency coverage for those people who are being evacuated, transferred, or otherwise dislocated as a result of the June 2008 flooding in Indiana and Iowa.
During a crisis it can often be impossible for providers to determine whether the 3-day stay requirement has been met and because of the disruptions in hospital care resulting from the flooding, hospitals serving disaster areas may need to discharge less critically-ill beneficiaries to a SNF sooner than usual due to overcrowding. There may also be cases in which skilled care is needed, and there is no available hospital bed due to the disaster. Applying the 3-day stay requirement could deny beneficiaries coverage to which they would have been entitled absent the disaster.
These temporary emergency policies apply to the geographic areas and timeframes specified pursuant to the Secretary's associated declarations of a Public Health Emergency pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act and the waivers for the States of Iowa and Indiana issued under section 1135 of the Act. Therefore, SNF coverage will be provided in the absence of a qualifying 3-day hospital stay for any Medicare beneficiary who:
- Was evacuated from a nursing home in the emergency area;
- Was discharged from a hospital (in the emergency or receiving locations) in order to enable the hospital to provide care to more seriously ill patients; or
- Needs SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the flooding.
In addition, CMS is recognizing special circumstances for beneficiaries who, prior to the May and June 2008 Iowa and Indiana flooding, had been recently discharged from an SNF after utilizing some or all of their available SNF benefit days. Existing Medicare regulations state that these beneficiaries cannot receive additional SNF benefits until they establish a new benefit period; (i.e., by breaking the spell of illness by being discharged to a custodial care or non-institutional setting for at least 60 days). Coverage for extended care services that will not require a new spell of illness by a SNF will be provided. Affected beneficiaries can then receive up to 100 additional days of SNF Part A coverage for care needed as a result of the Iowa and Indiana flooding.
Adoption of this policy will affect a small segment of Medicare beneficiaries who were recently discharged from an SNF after using benefit days and who:
- Were evacuated from a non-institutional setting in an emergency area;
- Need SNF care as a direct result of the May and June 2008 Iowa and Indiana flooding or its aftermath; or
- Were in the process of "breaking the spell of illness" for a prior SNF Part A stay, and would not normally be eligible for additional SNF Part A benefits.
Follow the instructions below when submitting SNF claims for services furnished as a result of the May and June 2008 Iowa and Indiana flooding and its aftermath:
- The receiving provider must document in the medical record both the medical need for the SNF admission and how the admission was related to the crisis created by the May and June Iowa and Indiana flooding and its aftermath.
- For verification/tracking purposes, the receiving provider should indicate "Iowa and/or Indiana Flooding" in the remarks section of the bill.
- The receiving provider should use condition code 58, which will bypass the 3-day stay requirement. The Occurrence Span Code 70 need not be reported.
The two policies described above are not limited to States that have been designated as emergency areas. Instead, the policies apply to all beneficiaries who were evacuated from an emergency area as a result of the Iowa and Indiana flooding, regardless of where the "host" SNF providing post-disaster care is located. These two policies will remain in effect until you receive notification that the 3-day qualifying stay requirement has reverted back to the instruction provided by the Internet-Only Manual (IOM).
Page Last Updated: Wednesday, 31-Dec-2008 10:49:22 CST
