In order to qualify for posthospital extended care services, the individual must have
been an inpatient of a hospital for a medically necessary stay of at least 3 consecutive
calendar days. In addition, effective 12/5/80, the individual must have been transferred
to a participating SNF within 30 days after discharge from the hospital, unless the
exception in subsection C.2. applies.
The hospital discharge must have occurred on or after the first day of the month in
which the individual attained age 65 or became entitled to health insurance benefits
under the disability or chronic renal disease provisions of the law. The 3 consecutive
calendar days requirement can be met by stays totaling 3 consecutive days in one or
more hospitals. In determining whether the requirement has been met, the day of admission,
but not the day of discharge, is counted as a hospital inpatient day.
To be covered, the extended care services must have been for the treatment of a condition
for which the beneficiary was receiving inpatient hospital services, or a condition
which arose while in the SNF for treatment of a condition for which he was previously
hospitalized. In addition, the qualifying hospital stay must have been medically necessary.
The 3-day hospital stay need not be in a hospital with which the SNF has a transfer
agreement. However, the hospital must be: (a) a participating general, psychiatric,
or tuberculosis hospital; or (b) an institution which meets at least the requirements
of an emergency services hospital.
Stays in Christian Science Sanatoriums are excluded for the purpose of satisfying
the 3 day period of hospitalization. Additionally, there is a prohibition of use of
waiver of liability days in meeting the 3 day requirement.
NOTE: While a 3 day stay in a psychiatric hospital satisfies the prior hospital stay requirement,
institutions which primarily provide psychiatric treatment cannot participate in the
program as SNFs. Therefore, a patient with only a psychiatric condition who is transferred
from a psychiatric hospital to a participating SNF is likely to receive only noncovered
care. In the SNF, the term “noncovered care” refers to any level of care which is less intensive and skilled than the SNF level
of care which is covered under the program. (See HI 00601.135.)
A stay of 3 or more days in a hospital outside the United States may satisfy the prior
inpatient stay requirement for post-hospital extended care services within the United
States if the foreign hospital is qualified as an “emergency hospital.”