Covid-19 Medicare Waivers to be Discontinued

At Hurley Elder Care Law, we navigate the complex rules and requirements of multiple state and federal benefit programs including Medicare and Medicaid so we can provide the most up-to-date legal plans and advice to our clients and partners.  The Covid-19 public health emergency (PHE) saw the implementation of many different waivers by the Centers for Medicare and Medicaid (CMS). These waivers were intended to provide flexibility, continuity of care and restrict red tape during unprecedented times. On May 11, 2023, these waivers will be discontinued. Let’s review which ones impact long-term care.

The waiver of the three-day hospital stay requirement prior to a Skilled Nursing Facility (SNF) stay.

One of the hallmarks of Covid-19 waivers, included the waiver of the Medicare three-day qualifying hospital stay requirement. On May 11, 2023 this waiver will be discontinued. What does that mean for people who did not have a QHS, are in a SNF now, or are admitted on or before May 11, 2023? The good news is that coverage will continue as long as the recipient has part A benefit days available and continues to meet the SNF level of care criteria.

What will things look like after May 11, 2023?

After May 11, 2023 we will return to the long-standing Qualifying Hospital Stay requirement. This means for Medicare to pay for someone to be admitted to a SNF as a short-term rehab resident, a person must have a 3-day admission (not observation) in a hospital whereupon the doctor feels a sub-acute rehabilitation stay is needed to maintain or improve functioning. This rehab care must be related to the hospital diagnosis; and after all the requirements are met, Medicare Part A will pay for days 1-20 at 100%.

As a reminder, many Medicare Advantage plans offer coverage of post-hospital SNF care in the absence of the prior qualifying hospital stay as part of their Medicare-covered benefits.

What about the 100-day waiver?

During the PHE, certain beneficiaries  who had exhausted their SNF benefits are eligible for a one-time  authorization to renew SNF coverage without first having to start and complete a 60-day “wellness period” (that is, the 60-day period of non-inpatient status that is normally required in order to end the current benefit period and renew SNF benefits). This waiver will also terminate on May 11, 2023.

Many of the PHE waivers will stay in effect such as access to Covid-19 vaccines, testing and treatment. You can read more about the specifics from CMS here.  At Hurley Elder Care law, we are committed to providing timely information to our clients and health care partners to better serve our community.  Please call our office at 404-843-0121 with questions and subscribe to our blog for further updates.