SNF - Skilled Nursing Facility - Definition

What Is a Skilled Nursing Facility?

A skilled nursing facility is a location dedicated to the care of individuals in a residential facility, usually there on a long-term basis. These facilities specialize in the 24-hour care and observation of individuals whose needs are usually critical enough where they need constant watching, but not serious enough where hospitalization is required.

A skilled nursing facility may often be called a nursing home by some people. They are often called that because nurses, of varying degrees and certifications, take on the bulk of the patient care work. They carry out this care by working closely with a patient's team of personal doctors, following those physicians’ directions and holding consultations as necessary. Doctors also make visits, in some cases, to skilled nursing facilities to provide check-up examinations.

Traditionally, a skilled nursing facility has been used for care of the elderly, leading to the somewhat unflattering term "old folks home." However, since that time, many skilled nursing facilities have added rehabilitation to their list of services. An individual may check into a skilled nursing facility, for example, to work on physical therapy after a surgery like a hip or knee replacement.

Often, these types of surgery limit mobility and make it problematic, especially for someone who lives alone. Being at a skilled nursing facility gives these individuals a chance to have round the clock care and also receive physical therapy services in the same location.

In general, a skilled nursing facility is an option for those who can no longer carry out the functions of daily lives, either on a temporary or permanent basis. Staff at a skilled nursing facility will help the individual with a number of everyday tasks, including bathing, eating, grooming and toileting.

In the United States, time spent at a skilled nursing facility can be expensive and not always covered by health insurance. This has led many individuals to consider getting a supplement to their normal health insurance coverage that will specifically cover nursing home care. A study reported by New York Life, an American insurance company, noted the average cost of a private room at a skilled nursing facility in the United States has increase to $204 US Dollars (USD) per day. The average price of a shared room is $180 USD per day. Prices were highest in the state of Alaska, where a private room costs more than $350 USD per day.

Room arrangements in a skilled nursing facility are similar to those in hospitals. They can be either private or shared. Similarly, bathrooms can be either private or shared.


NURSING FACILITY DETERMINATIONS

After the Medicaid application and MSA-2565-C have been submitted, the local MDHHS office determines eligibility for medical assistance. All allowable expenses and income are calculated, and any remaining income is considered excess income. Such excess income is then considered in determining the amount the beneficiary must pay toward his medical expenses each month. This monthly contribution by the beneficiary toward his care is called the patient pay amount.


Nursing facilities have the following options to obtain patient pay amount and eligibility information:

** DHS-3227 – If the local MDHHS office is unable to determine final eligibility status within five working days of receipt of the application for medical assistance, the Tentative Patient Pay Amount Notice (DHS-3227) is sent to the facility as notification of the person's tentative patient pay amount. When the final determination is made, a copy of the MSA-2565-C is returned to the facility.

** CHAMPS Eligibility Inquiry and/or other available eligibility options to obtain the Benefit Plan ID, LOC authorization, facility information and patient pay amount. (Refer to the Directory Appendix for contact and website information.)

The identity of residents in each facility is determined from the Medicaid Provider ID number and the NPI number entered on the MSA-2565-C submitted at admission or readmission.

It is very important that providers ensure that their provider numbers are valid.

CHAMPS Eligibility Inquiry and/or other available eligibility options should be used in the preparation of bills for services provided in that month. This avoids many billing problems stemming from eligibility information. The facility may contact the beneficiary's local MDHHS office as identified on the eligibility response if the information provided is incorrect.

The provider should contact MDHHS Provider Inquiry for answers to billing questions.



Facilities are responsible for collecting the patient pay amount. If the facility receives the DHS-3227, it indicates a tentative patient pay amount to be collected by the facility. In determining the tentative patient pay amount, MDHHS does not prorate for partial months. This amount is subject to change as the beneficiary's financial eligibility changes. The patient pay amount must be exhausted before any Medicaid payment is made.

A beneficiary who has a patient pay amount cannot legally be charged more than the Medicaid rate for a short stay in a facility. For example, if a beneficiary is in a long term care facility for two days in a month, the provider must collect no more than the Medicaid rate for two days from the patient pay amount (even if the patient pay amount For state-owned and -operated facilities, the following instructions apply:

** Item 13: attending physician - This item may be left blank.

** Item 19: if NF, specify per diem rate. The facility should enter its private pay routine nursing care per diem rate to facilitate determination of Medicaid eligibility.

Medicaid does not pay the facility services rendered if:

** The returned copy of the MSA-2565-C indicates the person is not eligible for Medicaid.

** The person has a divestment penalty (LOC Code 56).

1 comment:

Home Care said...

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