HI 00601.120 Coverage of Extended Care Services
Act—Sec. 1861(h), (i)
Regulations No. 5—Sec. 405.120
Post-hospital extended care services furnished to inpatients of an SNF were covered
under the hospital insurance program, effective January 1, 1967. Patients having hospital
insurance coverage are entitled, if the required conditions are met, to have payment
made on their behalf for the reasonable cost of covered extended care services furnished by the facility, or by the others under arrangements
with the facility. Coverage is subject to prior hospitalization and transfer requirements;
and to a determination that the patient's condition requires a covered level of care.
(See HI 00601.135.)
The term “extended” refers not to care over an extended period, but to active treatment as an extension of inpatient hospital care. The overall goal is to provide an alternative to hospital
care for patients who still require general medical management and skilled nursing
care or other skilled rehabilitation services on a daily basis, but who do not require
the constant availability of physician services ordinarily found only in the hospital
It is important that the limitations on extended care coverage be discussed in beneficiary
and public contacts, because of widespread misunderstanding. See HI 00601.125-HI 00601.230 following.