A skilled nursing facility, or SNF, is a temporary residence for patients undergoing medically necessary rehabilitation treatment. This treatment may be given under the same roof as a nursing home. However, the rehabilitative treatment is paid for differently and operates under different rules. When the treatment at a skilled nursing facility is complete, the patient may return to their more permanent place of residence.
What are the differences between Skilled Nursing Facilities and Nursing Homes?
A skilled nursing facility is a temporary residence for patients undergoing medically necessary rehabilitation treatment, while a nursing home is more of a permanent residence for people in need of 24/7 care.
These services may be under the same physical roof.
What Services Fall Under Skilled Nursing Care?
Skilled nursing is mostly regulated by the U.S. Department of Health and the Centers for Medicare & Medicaid Services (CMS). To be certified by CMS, skilled nursing communities must meet strict criteria and are subject to periodic inspections to ensure quality standards are being met.
Types of skilled nursing care
After a stroke, surgery, or extensive treatment for kidney, heart, or respiratory conditions, a patient may require nursing care following their release from the hospital. Medicare will pay for skilled nursing services if a physician prescribes specialized therapies–physical and occupational– medications, medical equipment and supplies, and social services. To qualify, however, the patient must go to a Medicare-certified skilled nursing community.
- In physical therapy, a rehabilitation care team will create a personalized plan to restore movement as much as possible.
- Occupational therapy helps in adapting to social and physical environments through specialized therapies for getting dressed, memory training, and coordination exercises.
- Speech therapy addresses communication issues and swallowing dysfunction. Speech and language pathologists design a treatment plan to help with language ability, provide alternate communication strategies, and give appropriate diet recommendations.
Skilled nursing staff may include:
- Registered nurses
- Licensed practical nurses
- Speech/language pathologists
- Licensed vocational nurses
- Medical directors
This type of care may be offered in hospitals, assisted living communities, Continuing Care Retirement Communities, nursing homes, and other certified locations. A Skilled Nursing Facility has dedicated staff for this kind of care.
How Is Skilled Nursing Care Paid For?
Does Standard Medicare Pay for Skilled Nursing Care?
For people enrolled in standard Medicare, Parts A and B, Medicare has provided a useful pamphlet of the policies around paying for skilled nursing care. A patient must have a qualifying hospital stay, which means a prior, medically necessary inpatient hospital stay of three consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you leave the hospital. Time a patient spends at the hospital under observation or in the emergency room before they are admitted doesn’t count toward the three-day qualifying inpatient hospital stay, even if the patient is there overnight.
A patient must enter the SNF within a short time (generally 30 days) of leaving the hospital. There are a variety of other rules and regulations, so it helps to read the pamphlet carefully.
Medicare only pays the entire cost of skilled nursing care for 20 days; thereafter, a patient is charged a copay of $200 for days 21 through100. If a patient stays the entire time, the total copay would be $16,000.
Medicare pays nothing beyond 100 days.
Does Medicare Advantage (aka Part C) Cover Skilled Nursing Care?
Medicare Advantage Plans (like an HMO or PPO) are offered by private companies approved by Medicare. (Source: U.S. Department of Health and Human Services)
If you join a Medicare Advantage (MA) Plan, the plan will provide all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and has different rules for how you get services (like whether you need a referral to see a specialist, or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency care). These rules can change each year. The majority of these plans are for profit and their profit is the difference between what Medicare pays them and what they pay for your care.
Each MA plan makes its own rules about how much skilled nursing care it will cover, for how long, and under what conditions. Recently, there have been reports of denial of skilled nursing care by these plans. It pays to be knowledgeable about the rules of your plan and the mechanisms to appeal a ruling.
Does Medicaid Cover Skilled Nursing Care?
If you are on Medicaid, consult your state’s rules as to what skilled nursing care and rehabilitation will be covered following surgery, illness, or injury. A doctor’s order will be required.
A skilled nursing facility is for temporary care. Other alternatives to in-home care can provide better long term care. Learn about: