House Bill Seeks to Abolish SNF Three-Day Rule

A bill reintroduced in the House of Representatives Wednesday aims to strip away a long-standing Medicare provision that places restrictions on beneficiaries who seek rehabilitation services in skilled nursing facilities (SNFs).

Known as the Creating Access to Rehabilitation for Every Senior Act (H.R. 4701)—or the CARES Act of 2017—the bill would eliminate Medicare’s three-day prior hospitalization requirement for coverage of skilled nursing care in qualified SNFs.

Sponsored by Rep. James Renacci, an Ohio Republican, the CARES Act was originally introduced in the House in 2015 during the 114th Congress; however, the bill was not enacted.


The three-day stay provision

Medicare beneficiaries are eligible for inpatient skilled nursing care or rehabilitative services in a SNF only when they have been admitted to the hospital as an inpatient for no fewer than three consecutive days, according to the Centers for Medicare and Medicaid Services (CMS).

This provision is commonly known as the SNF three-day rule. Medicare covers up to 100 days of SNF care per episode of care, but only in cases that involve a qualifying three-day inpatient hospital stay.


The rule has remained controversial in the skilled nursing space, with organizations such as AARP and the American Health Care Association lobbying for its removal. In recent years, industry objections have focused on so-called “observation stays,” in which patients stay overnight in hospitals for observation without ever being formally admitted.

Observation nights don’t count toward the three-day requirement, causing consternation and confusion among patients who may not even be aware their stays were observational — until they find out that subsequent SNF care isn’t covered under Medicare.

The CARES Act seeks to amend this section of the SSA by eliminating the three-day stay provision, extending care services without a prior hospitalization stay for beneficiaries.

“Effective for extended care services furnished pursuant to an admission to a skilled nursing facility that occurs more than 90 days after the date of the enactment of [the CARES Act], coverage shall be provided under this part for an individual for such services in a qualified skilled nursing facility that are not post-hospital extended care services,” the bill states.

‘Washington red tape’

In September 2013, the Commission on Long-Term Care called for legislation that would eliminate the requirement of a prior three-day inpatient stay in a SNF.

The Commission explained that with declining hospital lengths of stay, many inpatient stays that require post-acute skilled nursing may not qualify for coverage.

In broad strokes, the bill will “reduce barriers” to health care services that older adults need, according to a statement from Renacci’s office.

“The CARES Act will enhance access to quality care for our nation’s seniors by protecting the doctor-patient relationship and removing Washington red tape as a barrier to their health care,” Renacci said in the statement. “Beneficiaries in need of skilled nursing care are typically the frailest and oldest of the Medicare population, and they should not be shut out of these critical rehabilitation services due to Washington over-regulation.”

Further, the cause has a personal meaning for Renacci.

“As a former operator and manager of long-term care facilities in Northeast Ohio, I remain committed to finding bipartisan solutions that will allow Ohio seniors to receive the treatment they need at the time they need it,” Renacci said.

Written by Carlo Calma

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