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No Inpatient stay required for SNF Admit for Medicare Advantage Members

May 26, 2011

Fee-for-Service Medicare requires a qualifying 3-day inpatient stay prior to a Skilled Nursing Facility Admission. This 3-day acute inpatient stay is not required for Medicare Advantage members. In the appropriate circumstances, Medicare Advantage members can be directly admitted to a SNF (Skilled Nursing Facility). Most physician offices do these direct admissions to SNF so infrequently, there is often confusion, hesitation, and inappropriate selection of members (and/or services requested) during the direct admission to SNF process.

If the PCP wishes for the member to go to SNF directly from home, documentation of a skill for SNF services will need to be provided. If the skill will be therapy, a therapy evaluation needs to be obtained and provided. For WellCare members, Case Management Nurses at MED3000 will gladly assist any office with information and an authorization for a Home Health Care Physical Therapy evaluation for placement purposes. The typical procedure is that they send a Home Health Care MSW to the home to assist with placement in SNF as well. The PCP office will need to fill out nursing home orders on a 3008 form. The 3008 is the only acceptable form of orders for SNF admission. This completed form must accompany the member to the facility. If the member arrives at the facility without the completed 3008 they will not be allowed to stay. Medicare Advantage members and their families occasionally have to wait an unacceptable amount of time for SNF admission from home because this process is not followed.

Since direct admissions to SNF from home or Provider Office on fragile seniors are not an everyday occurrence, a knowledge deficit can exist on the process. Health First Network Providers can contact the Case Management Department at MED3000 for any assistance needed, for questions or for more information on the SNF Auth and admission process. The MED3000 Case Management Department can be reached at 478-6060, ext 3231.

The 3008 Medical Certification Form for Skilled Nursing Admission can be found at the following link along with other pertinent information.

3008 Medical Certification Form

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