HI 00601.270 Extended Care Benefit Days

A. General

A patient having hospital insurance coverage is entitled subject to the coinsurance requirement (HI 00601.570) to have payment made on his behalf for up to 100 days of covered inpatient extended care services in each benefit period. (See HI 00401.340.)

B. Inpatient day defined

The number of days of care charged to a beneficiary for inpatient extended care services is always in units of full days. A day begins at midnight and ends 24 hours later. The midnight-to-midnight method is to be used in reporting days of care for beneficiaries, even if the facility uses a different definition of day for statistical or other purposes.

A part of a day, including the day of admission, counts as a full day. However, the day of discharge, death, or a day on which a patient begins a leave of absence is not counted as a day. (Charges for ancillary services on the day of discharge, death, or the day on which a patient begins a leave of absence are covered.) If admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one inpatient day.

C. Late discharge

When a patient chooses to occupy his accommodations in an SNF beyond the normal check-out time for personal reasons, the SNF may charge the beneficiary for his continued stay. Such a stay beyond the check-out time, for the comfort or convenience of the patient, is not covered under the program and the SNF's agreement to participate in the program does not preclude the facility from charging the patient. However, it is expected that facilities will not impose late charges on a beneficiary unless he or she has been given reasonable notice (for example, 24 hours) of his impending discharge.

Where the patient's medical condition is the cause of the stay past the discharge hour (e.g., the patient needs further services, is bedridden and is awaiting transportation to his home, or dies in the facility), the stay beyond the discharge hour is covered under the program and the SNF may not charge the patient.


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http://policy.ssa.gov/poms.nsf/lnx/0600601270
HI 00601.270 - Extended Care Benefit Days - 05/08/2014
Batch run: 05/08/2014
Rev:05/08/2014