When a Medicare patient has been treated for three days or more as an admitted inpatient in a hospital, they may need subacute treatment for maintenance of their fragile condition, or for cognitive or physical rehabilitation. If a physician prescribes those services and they need to be performed by licensed personnel (nurses, physicians, physical and occupational therapists, for example) in an institution, then Medicare Part A will pay for up to 100 days of both care and room & board (it pays 100% for the first 20 days and 80% after that).
Most patients have a “Medi-Gap” supplemental policy which pays for the copayments and deductibles for services that Medicare has otherwise approved. When selecting a subacute facility, the patient may be steered to one that is within the hospital’s network. However, the patient does have freedom of choice, at least to the extent of finding a facility that their medi-gap policy will pay for. If you are not sure which facilities are in your network, help is available through private companies that serve as insurance plan advocates, as well as from the assigned hospital discharge planner.
There have been reports about nursing homes converting part of their facility into an alleged “rehabilitation” center, in order to score Medicare dollars, without fully complying with the myriad egulations and requirements. I haven’t personally encountered that in New Jersey, but take a look at NY Times 4-15-15. It got me thinking, so here are suggestions on questions to ask:
Is the facility licensed to provide subacute skilled rehabilitative and nursing care? What’s the size of the skilled care operation? What are the credentials of the licensed staff? How long has this place been providing skilled rehab services? Check the New Jersey State Nursing Home Survey done by the NJ Dept of Health concerning licensing – inspections – infractions– and remediation that’s been ordered. Does the facility participate in Medicaid (in case the patient may be staying for long term)? If not, does it have a sister facility which does participate in Medicaid (I just recently had to arrange a transfer for one of my clients because of this latter problem). How soon will they meet with the patient and family to develop the skilled care treatment program? How will they work with the patient to coordinate the discharge back home?
The patient’s advocate may want to visit the facility in advance of discharge from the hospital, especially on a weekend, to see what the level of staffing is. Hospital discharge can be sprung on you suddenly without much notice, so it’s smart to try to stay one step ahead of them in this process.
For legal advice and representation concerning legal problems involving hospital discharges and transfers to or discharged from skilled care facilities, contact us at 732-382-6070.