If your loved one can benefit by short term rehabilitative therapy such as physical therapy, occupational therapy (for activities of daily living) or speech therapy, they can receive care via a short-term stay in a rehabilitation hospital or a skilled nursing facility. This article discusses discharge from a hospital to an inpatient rehabilitation center. Before reading this article, read our general article about “How to Manage Your Loved One’s Discharge from a Hospital or Rehabilitation Center” which explains how to: The United Hospital Fund, via its Next Step in Care* program, publishes a family caregiver’s guide to “Short-Term Rehab Services in an Inpatient Setting.” Among the topics addressed in the guide are: Inpatient rehabilitation settings include: Determine your loved one’s insurance coverage for the services they will need: By law, hospitals must give patients a choice of the provider they will use for their rehabilitation, home health care, hospice, etc. Many hospitals own such services, however your loved one may benefit from using a different provider. You can help your loved one choose a provider and work with the discharge planner and the provider to set up that referral and transition. Discharge planners often choose providers based on availability. By arranging discharges in advance with the provider, you may be able to arrange a more orderly discharge to your loved one’s provider of choice. Things to consider when choosing a provider: The National Institute of Health US National Library of Medicine provides guidance on Choosing a Rehabilitation Facility. The Center for Medicare Advocacy recommends these ways to choose skilled nursing facility. Medicare provides comparisons between providers: Inpatient Rehabilitation Facility Compare To arrange for discharge to a particular facility, contact the admissions personnel at that facility to determine whether they have a bed available. (You can do this yourself - you do not need to work through the hospital discharge planner.) If the discharge planner says there is not a bed at your preferred facility, call the facility yourself to make sure. If the admissions person at the rehabilitation facility confirms they can receive your loved one, contact the discharge planner at the hospital, communicate which facility your loved one has chosen, tell the discharge planner that the receiving facility has agreed, and ask the discharge planner to communicate discharge instructions to the facility. Confirm with the rehabilitation facility that they have received the referral from the hospital and the discharge is arranged. Be sure to determine your loved one’s insurance coverage of their stay in a skilled nursing facility (SNF). Medicare coverage of a skilled nursing facility stay depends on several factors, which are detailed below. As of March of 2019, you pay the following (Check Medicare.gov for current costs): Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a SNF in certain conditions for a limited time (on a short-term basis) if all of these conditions are met. 1. You have Medicare Part A* (Hospital Insurance) and have days left in your benefit period available to use. 2. You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you leave the Hospital. Important Note You must enter the SNF within a short period of time (generally 30 days) of leaving the hospital. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you may not need another qualifying 3-day hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days. 3. Your doctor has ordered the inpatient services you need for SNF care, which require the skills of professional personnel like registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists, or audiologists, and are furnished by, or under the supervision of, these skilled personnel. 4. You get the required skilled care on a daily basis and the services must be ones that can only be provided in a SNF on an inpatient basis. If you’re in a SNF for skilled therapy services only, and these services aren’t available at the SNF 7 days a week, your care is considered dailycare even if the therapy services are offered just 5 or 6 days a week. 5. You need these skilled services for: 6. The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition. 7. You get these skilled services in a Medicare-certified SNF. If you are a long distance caregiver or already busy with career and family responsibilities, you may not be able to coordinate your loved one’s discharge to an inpatient rehabilitation center. Care is There can help. We can: Also, read our article about Managing a Stay in a Rehabilitation Center. * The United Hospital Fund requires the posting of this disclaimer when linking to their website: “The United Hospital Fund is not responsible for information or advice provided by others, including information on websites that link to Next Step in Care and on third party sites to which the Next Step in Care links. Please direct any questions to nextstepincare@uhfnyc.org.”General Discharge Planning
Managing a Discharge to an Inpatient Rehabilitation Center
Inpatient Rehabilitation Settings
Clarify Insurance Coverage and Other Financial Options
Choose the Inpatient Rehabilitation Center
Medicare Coverage of Skilled Nursing Facility Care
Costs of Skilled Nursing Facility Care Under Original Medicare
Requirements for Medicare Coverage of a Skilled Nursing Facility
You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Time you’re being observed in a hospital or in an emergency room before you’re admitted doesn’t count toward the 3-day qualifying inpatient hospital stay. You may be classified as “outpatient” or “observation status” even if you spend the night in the hospital, so it is critical to verify that you have spent three days in the hospital under an inpatient classification. Otherwise, Medicare will not pay for your skilled nursing stay. See our article on “Hospital Observation Status”.
How Care is There can Help:
Resources for Inpatient Rehabilitation
Next Steps
Can’t be with your loved one to manage their discharge from the hospital to a rehabilitation center? We can help!
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