There are approximately 13.2 million hospitalizations among adults aged 65 years and older in the United States each year, with one in four Medicare patients discharged to a skilled nursing facility (SNF) following acute hospitalizations.
Before the pandemic, Medicare beneficiaries were required to have a prior inpatient hospital stay of three consecutive days to be eligible for Medicare coverage of inpatient SNF care. Under the federal Public Health Emergency (PHE) for COVID-19, put into effect by the Department of Health and Human Services in January 2020, this 3-Day Rule was waived, allowing temporary emergency coverage of SNF services to beneficiaries without a qualifying hospital stay, and extension of benefits for qualifying patients up to an additional 100 days.
While the 3-Day stay waiver helped ensure patients had access to care during the pandemic, the impact it has had on the nation’s SNFs varies.
In February, the Biden Administration announced plans to end the federal PHE on May 11, 2023. With the PHE’s ending, some provisions will remain in effect, while others will be discontinued, including waiver of the SNF 3-Day Rule for Medicare beneficiaries. This is poised to impact SNFs yet again, as the nation works to return to pre-pandemic operations.
“While the immediate threat of the pandemic may be over, we understand the end of the PHE may pose a challenge to the nation’s skilled nursing facilities,” said Dr. Tony Gamboa, Chief Growth and Innovation Officer. “Some operators still face resource challenges and declining financial health due to residual staffing and regulatory challenges, and the end of the PHE isn’t welcome news for everyone. Curana Health has developed benefits similar to the 3-Day Rule and has the ability and experience to help partners navigate through the transition, regardless of position, and help return to operational efficiency.”
Curana Health’s ability to provide an equivalent benefit to the PHE is unparalleled. Waiver of the 3-Day Rule has always been a benefit of Align Senior Care, which is fully owned and operated by AllyAlign Health (AAH), our Medicare Advantage health plans. And starting on January 1, Curana Health Medical Group’s participation in the High Needs ACO REACH program will allow our clinicians to authorize “skill in place” episodes for qualifying residents in our partner facilities. Curana estimates that the combination of our ACO and Medicare Advantage solutions can retain “skill in place” for as many as 80% of nursing home residents.
Whether the PHE end is welcome news, or poses challenges, we are here help operators establish a more permanent path to financial and operational viability. Improving the health, dignity, and wellness of seniors through value-based care is at the heart of our mission – and a shared value in the communities and facilities we partner with.
We understand no two SNFs are alike. Each has unique needs relevant to their regions and populations. But we also believe all SNFs share the same goal – to help seniors live their most fulfilling life through great care. We welcome the role we can play to pour partners and look forward to guiding operators through the ever-changing post-pandemic world.
To read more about the PHE transition and areas changed/unchanged read here.