Ask Proactive – I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation?

I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation?

A:

Possibly, but timing matters.  An interrupted Stay is a Medicare Part A SNF stay in which a resident is discharged from SNF care (i.e., the resident is discharged from a Medicare Part A-covered stay) and subsequently resumes SNF care in the same SNF for a Medicare Part A-covered stay during the interruption window. The Interruption Window is a 3-day period, starting with the calendar day of Part A discharge and including the 2 immediately following calendar days. In other words, if a resident in a Medicare Part A SNF stay is discharged from Part A, the resident must resume Part A services, or return to the same SNF (if physically discharged) to resume Part A services, by 11:59 p.m. at the end of the third calendar day after their Part A-covered stay ended. The interruption window begins with the first non-covered day following a Part A-covered stay and ends at 11:59 p.m. on the third consecutive non-covered day following a Part A-covered SNF stay. If these conditions are met, the subsequent stay is considered a continuation of the previous Medicare Part A-covered stay for the purposes of both the variable per diem schedule and PPS assessment completion.