Ask Proactive – We have a patient who received a skilled stay (34 days) using the spell of illness waiver (related to positive COVID condition and clinical needs). She just returned from the hospital outside her 30-day window, but still has 38 days remaining in the benefit period. Can we skill her again? How many times can we use the waiver for a patient?

We have a patient who received a skilled stay (34 days) using the spell of illness waiver (related to positive COVID condition and clinical needs). She just returned from the hospital outside her 30-day window, but still has 38 days remaining in the benefit period. Can we skill her again? How many times can we use the waiver for a patient?

A:

It appears that beneficiaries cannot access the waiver for spell of illness more than once. But, if your patient had a 60 day break, then she could access the waiver for qualifying hospital stay when skilled services are indicated.   AHCA’s COVID-19 3-Day Stay & Benefit Period Waiver FAQ’s addresses a similar question:

Q 12. Are the benefits of the QHS Waiver renewable throughout the PHE, or is this a one-time use (up to 100 days)

A 12. AHCA has confirmed with CMS during the PHE that the QHS waiver can be used multiple times for the same beneficiary in the following situation: The beneficiary has had a 60-day break since the last day requiring a SNF level of care. Therefore, other than the one-time spell of illness waiver option, the QHS waiver in itself is not renewable. However, once the beneficiary has had a 60 day or more “wellness period”, then he/she would be eligible for a subsequent QHS waiver under a new benefit period.