REMINDER: 1135 Waiver of 3-Day Stay still in effect

• By: Danielle Watford
• On: 07/23/2021 11:41:35
• In: COVID-19

As you know, HHS renewed the Public Health Emergency (PHE) on July 20. The PHE renewal also extends all Section 1135 waivers, irrespective of a state's PHE status – the federal waivers remain in place. We have heard from some members regarding the status of the SNF 3-Day Stay Waiver and would like to provide a quick update from AHCA. 
 
Based upon the federal PHE renewal:

• 3-Day Stay Waiver Remains in Effect:  The waiver language is unchanged:  “3-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).”  SOURCE:  CMS Waiver Document located at https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf

• SNF Providers Do Not Need Hospital Documentation:  The 3-Day Stay Waiver is intended to free up as many hospital beds as possible by allowing beneficiaries who meet the Skilled Care Criteria to be directly admitted to a SNF. In regard to documentation, SNFs need only document that the beneficiary meets the SNF Criteria for Skilled Care and code claims associated with waiver stays using the disaster billing codes. Billing instructions are located here:  https://www.cms.gov/files/document/se20011.pdf

• AHCA 3-Day Stay Guidance:  AHCA also developed 3-Day Stay guidance for the membership. This guidance is located here:  https://www.ahcancal.org/Survey-Regulatory-Legal/Emergency-Preparedness/Documents/COVID19/3-Day%20Waiver%20FAQ.pdf  You will note this document indicates the waiver guidance is “until April 21, 2021.” This is an anachronism which we will correct.