Medicare Beneficiaries May Qualify for an Additional Pandemic-Related Benefit

As of October 4, 2020, almost 60,000 nursing home residents have died from coronavirus. Nursing homes were hit particularly hard by the disease. But COVID-19 also disrupted medical treatment for Medicare beneficiaries who needed skilled nursing care. However, residents covered by Medicare now might qualify for an additional 100 days in a skilled nursing facility.

Skilled Nursing Facility Care for Medicare Beneficiaries

Medicare typically does not cover long-term care. However, Section 1861(i) of the Social Security Act allows qualified recipients to receive up to 100 days of care in a skilled nursing facility:

  • The beneficiary must have been in the hospital for at least three days before moving to the facility; and
  • The beneficiary must need skilled nursing care.

For example, Walter asked Medicare to cover his time in a skilled nursing facility. He was leaving the hospital after ten days but still needed skilled nursing care. Medicare was able to pay for up to 100 days of skilled nursing care because Walter met the above criteria.

Coverage for a spell of illness ends after 100 days. Patients may be eligible for more care if a new spell of illness begins, as long as they have not received skilled care for 60 consecutive days.

By day 82, Walter was well enough to return home, and his spell of illness ended. However, 62 days later, his doctors said he needed skilled nursing care again after being hospitalized for three days. Medicare could pay for another 100 days of skilled nursing care since this should be considered a new spell of illness.

Please note that Medicare beneficiaries can remain at the skilled nursing facility after exhausting their 100 days of coverage. As long as they receive only custodial care, they may qualify for skilled nursing care again after 60 days.

Walter could have stayed at the skilled nursing facility and used another method of payment. After 60 days of custodial care only, he probably would qualify for another 100 days of skilled nursing care.

The coronavirus public health emergency affected patient care. It also altered the way Medicare handles Medicare beneficiaries that need skilled nursing care.

An Additional, Pandemic-Related Benefit

Medicare recognized that the coronavirus public health emergency disrupted much-needed care for some people. For some, their 100 days ran out while their care was interrupted or delayed. On March 13, 2020, Medicare issued a letter waiving the spell of illness requirement.

People whose care was disrupted by COVID-19 now may have an additional 100 days for skilled nursing care. A COVID-19 diagnosis is not required. What matters is that the public health emergency interrupted or delayed treatment. Also, Medicare will waive the three-day hospitalization requirement in some cases.

During Walter’s first 100 days of skilled nursing care, his treatment was interrupted because of COVID-19. In fact, some of his treatments were delayed for two months. He remained in the facility but received basic care. Because Medicare waived the spell of illness requirement, Walter probably qualifies for another 100 days of skilled nursing care.

Medicare Beneficiaries with Questions Can Talk to an Elder Law Attorney.

Attorney Robert Slutsky was one of the first lawyers in Pennsylvania to focus on elder law issues, including Medicaid and Medicare. He’s helped countless people find solutions that work for their individual situations.

Please give us a call at (610) 940-0650 or schedule a consultation on our website. We help clients throughout Chester, Delaware, Montgomery, Bucks, and Philadelphia Counties and beyond.

For a listing of skilled nursing and rehabilitation facilities please check out our Chester County PA Elder Law Directory and Senior Guide online at:

www.chescoseniorguide.com.

www.montcoseniorguide.com

www.delcoseniorguide.com

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