HI 00601.120 Coverage of Extended Care Services

Citations:

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 setting.

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.