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].