AHCA Skilled SNF Coverage Decisions Under COVID-19 Waivers Flowcharts

CMS recently updated their SNF Medicare Part A coverage waiver guidance . AHCA has developed visual flowchart guidance to help providers understand when longstanding CMS SNF Part A coverage policies apply, or when and how the Section 1135 waivers may be applied in various scenarios, including admissions and readmissions from hospitals, direct admissions from the community, and whether a SNF long-stay resident can be “skilled-in-place”.

Below are links to documents that contain flowcharts and step-by-step guidance to help providers identify whether a particular beneficiary is eligible for Part A benefits under: 1) normal coverage policies, 2) the COVID-19 3-day stay waiver, or 3) the COVID-19 spell-of-illness waiver, as well how a claim can be coded to indicate that a COVID-19 waiver applied to the beneficiary.

• Beneficiary is Hospital Inpatient (Community Admission or SNF Readmission)
• Beneficiary Admission From Community, ER, or Hospital Observation Stay

Beneficiary is SNF Long Term Care Resident (Skill-in-Place)