Centers for Medicare & Medicaid Services — To the Secretary, Section 1812(f)
Summary
A memorandum from the Administrator of the Centers for Medicare & Medicaid Services to the Secretary states findings concerning Section 1812(f) of the Social Security Act in response to the effects of the 2019-Novel Coronavirus (COVID-19) Outbreak. It finds that covering skilled nursing facility (SNF) care without a 3-day inpatient hospital stay for affected beneficiaries would not increase total payments made under the Medicare program. SNF care without a 3-day stay will therefore be covered for beneficiaries such as those evacuated from a nursing home in the emergency area. It also provides renewed coverage for extended care services without a new spell of illness, for up to an additional 100 days of SNF Part A coverage.
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“Centers for Medicare & Medicaid Services — To the Secretary, Section 1812(f).”
Original at www.cms.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/ppr-int-1c8ecead7399ba63-approved-coronavirus-1812-f-waiver-pdf-b2b6d4-0700a047a0/
, SHA-256 b5cfa9e6c1d0ffbde7e9817949b38a9dba9d5dab851609e6dd24a93029cf5ef2.Full text
DEPARTMENT OF HEAUIH & HUMAN SERVICES Centers tor l\ledicaro & lvledicaid Services
Admiústrøtor
l.lAR I 3 2020 Washington, DC 20201
TO: The Secretary
Thlough DS
cos_
ES
FROM: Administrator
Centers for Medicare & Medicaid Services
SUBJECT: Findings Concerning Section 1812(f) ofthe Social Security Act in Response to
the Effects of the 2019-Novel Coronavirus (COVID-19) Outbreak
These findings are based on the public health emergency that you declared under Section 319 of
the Public Health Service Act as a result ofthe consequences ofthe above-captioned emergency,
and are effective with respect to the timeframes and geographic areas specified in the waiver(s)
issued under section 1135 ofthe Social Security Act (the Act) in response to that emergenoy.
Accordingly, both the effective date(s) and expiration date(s) for these temporary emergenoy
policies are the same as those specified pursuant to the coresponding section 1135 waiver(s).
Section 1861(i) of the Act permits Medicare payment for skilled nursing facility (SNF) care only
when a beneficiary first has an inpatient hospital stay ofat least 3 consecutive days. section
1812(f1 of the Act allows Medicare to pay for sNF services without a 3-day qualifying stay if the
secretary of Health and Human Services finds that doing so will not increase total payments
made under the Medicare program or change the essential acute-care nature of the SNF benefit. I
find thal covering SNF care without a 3-day inpatient hospital stay only for beneficiaries affected
by the above-captioned emergency (with respect to the timeframes and geographic areas
specified in the waiver(s) issued under section 1 135 of the Act as a result ofthat emergency)
would not increase total payments made under the Medicare program and would not change the
essential acute-care nature of the Medicare SNF benefit. Therefore, SNF care without a 3-day
inpatient hospital stay will be covered for beneficiaries who experience dislocations or are
otherwise affected by the emergency, such as those who are (1) evacuated from a nursing home
in the emergency area, (2) discharged from a hospital (in the emergency or receiving locations)
in order to provide care to more seriously ill patients, or (3) need SNF care as a result ofthe
emergency, regardless of whether that individual was in a hospital or nursing home prior to the
emergency.
In addition, we will recognize special circumstances for certain beneficiaries who, prior to the
cunent emergency, had either begun or were ready to begin the process ofending their spell of
illness after utilizing all oftheir available SNF benefit days. Existing Medicale 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 c¿re or non-
institutional setting f'or at least 60 days). However, the dislocations resulting from the emergency
(including emergency-related measures that could resuh in discharge clelays) may delay or
prevent such beneficiaries from commencing or completing the process ofending their cument
beneht period and renewing their SNF benefits that would have occuned under normal
Page2 - The Secretary
circumstances. Accordingly, I find that covering additional SNF care without requiring a break
in the spell of illness for those beneficiaries in connection with the above-captioned
emergency would not increase total payments made under the Medicare program and would not
change the essential acute-care nature of the Medicare SNF benefit. Therefore, we are also
utilizing the authority under section l8l2(Ð of the Act to provide renewed coverage for extended
care services which will not first require starting a new spell of illness for such beneficiaries,
who can then receive up to an additional 100 days of SNF Part A coverage for care needed as a
result of the above-captioned emergency. This policy will apply only for those beneficiaries who
have been delayed or prevented by the emergency itself from commencing or completing the
process of ending their current benefit period and renewing their SNF benefits that would have
occurred under normal circumstances.
Any patients discharged from a hospital to the SNF or admitted directly from home to the SNF
should be managed in accordance with the latest CMS or CDC guidance.
Verma
strator
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