Compliance

THIC ACO SNF 3-Day Rule Waiver

Eligible Medicare Patients Can Receive Skilled Nursing and Rehabilitation Care without a 3-Day Prior Hospital Stay at Eligible SNFs.

[Doctor/Practice name is OR “I am”] participating in Trinity Health Integrated Care, a Medicare Shared Savings Program Accountable Care Organization (ACO). An ACO is a group of doctors, hospitals, and/or other health care providers working together with Medicare to give you better, more coordinated service and health care.

As of January 1, 2017, the Medicare rule that requires people with fee-for-service Medicare to have a hospital stay of at least 3 consecutive days before being admitted to a skilled-nursing facility (SNF) for “skilled” nursing and/or rehabilitation care has been waived, under certain circumstances for Medicare beneficiaries who receive care from certain ACOs participating in the Shared Savings Program. This is called the SNF 3-Day Rule Waiver. Trinity Health Integrated Care is approved for the SNF 3-Day Rule Waiver.

Historically, Medicare patients had to complete a medically necessary consecutive 3-day stay in a hospital before Medicare would pay for their SNF nursing and/or rehabilitation care. The SNF 3-Day Rule Waiver allows eligible SNFs that have partnered with an ACO to bill Medicare for certain patients’ SNF care, even if they haven’t had a prior consecutive 3-day inpatient hospital stay before being admitted to the eligible SNF. This means that if you need skilled nursing and/or rehabilitation care, your physician who is participating in Trinity Health Integrated Care may admit you to an eligible SNF without you first having to go to the hospital or having a consecutive 3-day inpatient hospital stay. This allows [“us”/“me”] to be more flexible with the care [“we”/“I”] recommend for you. The waiver is also available to beneficiaries who are admitted to the hospital, but do not have a full 3-day stay.

Your SNF benefit does not change. The SNF 3-Day Rule Waiver does not create a new Medicare benefit or eliminate any of the other requirements for Medicare coverage of SNF services. [Doctor/Practice name OR “I”] will still determine if you need skilled nursing and/or rehabilitation care.

Also, you still have your choice of doctors, hospitals, and SNFs. The SNF 3-Day Rule Waiver applies to eligible patients who get care from one of our SNF partners. If you choose a SNF or other facility Trinity Health Integrated Care does not have an agreement with, normal Medicare coverage requirements apply. This includes the requirement for a consecutive 3-day inpatient hospital stay prior to your admission to a SNF. See a list of our SNF partners below.

The Cottages at Garden Grove
Elderwood at Liverpool
Oneida Healthcare
Rome Memorial Hospital
Charles T. Sitrin Health Care Center
Syracuse Home Association

The SNF 3-Day Rule Waiver also does not change how much you would pay for SNF care. If you are admitted to one of our SNF partners, the typical cost sharing requirements will still apply.

Questions?

[“We are”/“I am”] glad to talk with you about the SNF 3-Day Rule Waiver and how it could apply to you if you need skilled nursing and/or rehabilitation care. [“We”/ “I”] can also share information about our SNF partners. Please ask about it at your next visit with [Doctor/Practice name OR “me”]. Or call us at [phone number].

THIC ACO Patient Letter 2024

Notice to Patients

[Name of Office/Practice/Provider] is part of an Accountable Care Organization (ACO). We’ve teamed up with other doctors, hospitals, and health care providers to make sure you get the best care. We provide coordinated care for you to get well & stay well

You get patient-centered care focused on YOUR needs.
Your health care providers can see the same test results, treatments, and prescriptions.
More coordination helps prevent medical errors and drug interactions.
You may save time, money, and frustration by avoiding repeated tests and appointments.
Better communication can help protect against Medicare fraud and waste. •
We may offer telehealth services which let your primary care doctor care for you without an inperson visit, no matter where you live. If you need rehabilitation services or other skilled nursing facility care, you may be able to get this care without a hospital stay. Ask your health care provider if you qualify for these benefits.

Ask about signing up for our secure online portal. You’ll get 24-hour access to your personal health information, including lab results and communication from your health careprovider. When you choose a health care provider that participates in an ACO, they’ll help you get the

right care at the right time. You can visit Medicare.gov and log into (or create) your secureMedicare account to choose a primary care doctor. Medicare protects the privacy of your health information. If you don’t want Medicare to share

information with your health care providers for care coordination, call 1-800-MEDICARE (1-800-633-4227). Medicare may still share general information to measure provider quality. For moreinformation on how Medicare may use and give out your information, visit Medicare.gov andsearch for “privacy.”

Questions?

Ask our front desk, or call us at [add phone number]. You can also visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. To report a Medicare-related concern or complaint, call 1-800-MEDICARE (1-800-633-4227). Learn more about Accountable Care Organizations here: • •

You may have access to expanded benefits Get the most from your care with our communication & support Want more information?
Having Your Health Information Gives Us a More Complete Picture of Your Health
Your Privacy is Very Important to Us

To help Trinity Health Integrated Care give you better, coordinated care, Medicare will share information with us about your care. The information will include things like dates and times you visited a doctor or hospital, your medical conditions, and a list of past and current prescriptions.

This information from other health care providers will give [Doctor/Practice name OR “me”] and other health care providers in ACOs a more complete and up-to-date picture of your health. Over time, you may notice that you don’t have to fill out as many medical forms that ask for the same information, you don’t need to repeat medical tests because your results are shared among your health team, and other benefits because your providers are communicating with one another.

If you choose to let Medicare share your health care information with Trinity Health Integrated Care , it may also be shared with other ACOs in which your other doctors or health care providers participate. If you don’t want your health care information shared, you can ask Medicare not share it.

Just like Medicare, ACOs must put important safeguards in place to make sure all your health care information is safe. ACOs respect your choice on the use of your health care information for care coordination and quality improvement.

Yes, share my information: If you want Medicare to share information about the health care you received with Trinity Health Integrated Care or with other ACOs in which your other doctors or health care providers participate, there’s nothing more you need to do.

No, please don’t share my information: If you do not want Medicare to share your health care information, you need to do the following:

  • Call 1-800-MEDICARE (1-800-633-4227). Tell the representative that your doctor is part of an ACO and you do not want Medicare to share your health care information. TTY users should call 1-877-486-2048.
  • If you change your mind in the future, call 1-800-MEDICARE and tell the representative what you have decided. We can’t communicate with Medicare on your behalf.

Even if you decline to share your health care information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the providers participating in ACOs. Also, Medicare may share some of your health care information with ACOs when measuring the quality of care given by health care providers participating in those ACOs.

THIC ACO Poster for Practices 2024

[Name of Office/Practice/Provider] is part of an Accountable Care Organization (ACO). We’ve teamed up with other doctors, hospitals, and health care providers to make sure you get the best care. We provide coordinated care for you to get well & stay well

  • You get patient-centered care focused on YOUR needs.
  • Your health care providers can see the same test results, treatments, and prescriptions.
  • More coordination helps prevent medical errors and drug interactions.
  • You may save time, money, and frustration by avoiding repeated tests and appointments.
  • Better communication can help protect against Medicare fraud and waste.

Ask about signing up for our secure online portal. You’ll get 24-hour access to your personal health information, including lab results and communication from your health care provider. When you choose a health care provider that participates in an ACO, they’ll help you get the right care at the right time. You can visit Medicare.gov and log into (or create) your secure Medicare account to choose a primary care doctor. Medicare protects the privacy of your health information. If you don’t want Medicare to share your health information with your doctors for care coordination, call 1-800-MEDICARE (1-800-633-4227). Medicare may still share general information to measure provider quality. For more information on how Medicare may use and give out your information, visit Medicare.gov and search for “privacy.”

Get the most from your care with our communication & support Want more information?

Ask our front desk, or call us at [add phone number]. You can also visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Learn more about Accountable Care Organizations here:

  • An ACO is a group of doctors and other health care providers who voluntarily work together with Medicare to give you high quality service and care at the right time in the right setting.
  • [Doctor/Practice Name is OR “I am”] participating in Trinity Health Integrated Care, a Medicare Shared Savings Program ACO.
  • An ACO is not a Medicare Advantage Plan, (like an HMO or PPO), or an insurance plan.
  • ACOs don’t change your Medicare benefits.
  • Your doctors will have a more complete picture of your health through talking with your other doctors.
  • To help you get better, more coordinated care, Medicare will share certain health information with us about the care you get from your doctors and other health care providers unless you ask Medicare not to share it. Medicare may also share your health information with other ACOs in which your other doctors or health care providers participate.
  • [Doctor’s Name OR Practice Name] may continue to recommend that you see particular doctors for your specific health needs, but it’s always your choice about what doctors you see or hospitals you visit.
  • If you want Medicare to share information about the health care you received with Trinity Health Integrated Care or with other ACOs in which your other doctors or health care providers participate, there’s nothing more you need to do.
  • If you do not want Medicare to share your health care information, you need to call 1-800 MEDICARE (1-800-633-4227) and tell the representative that your doctor is part of an ACO and you don’t want Medicare to share your health care information. TTY users should call 1-877-486-2048.
  • If you change your mind in the future, you can call 1-800-MEDICARE and tell the representative what you have decided. We can’t communicate with Medicare on your behalf.
  • Even if you decline to share your health care information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the providers participating in ACOs. Also, Medicare may share some of your health care information with ACOs when measuring the quality of care given by health care providers participating in those ACOs.