Our 5-Question quiz will help you make certain you understand PDPM's new Interrupted Stay Policy
A 3-day window between discharge and readmission will determine whether a patient is considered a new or interrupted stay in the nation's skilled nursing facilities under new Medicare requirements taking effect Oct. 1.
The new Interrupted Stay Policy is one of many changes ahead for skilled nursing facilities (SNFs) under Medicare’s new Patient-Driven Payment Model (PDPM). The policy will affect the per diem rate paid for SNF patients with multiple stays.
“PDPM will completely change the way skilled nursing facilities are reimbursed, and the variable per diem rate will be one of the components used to determine reimbursement,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm which has served the home health and hospice industries since 2012.
Her Alabama-based company has launched a new long-term care solutions division known as LTC Solutions in anticipation of a PDPM-inspired need among skilled nursing facilities for training, consulting and outsourcing.
“The new Interrupted Stay Policy under PDPM is important,” J’non said. “Per diem rates taper off during the length of a patient’s stay, so whether a patient returning to a skilled nursing facility after an in-patient stay at a hospital is considered an interrupted stay or a new admission will determine the per diem rate for that patient.”
(Read our previous blog post detailing the new Interrupted Stay Policy here. ) The 3-Day Window
A three-day window will be the determining measure for whether a resident’s readmission is to be considered an interrupted stay or a new stay under the new policy.
The Centers for Medicare and Medicaid Services (CMS) defines an interrupted stay as one in which a patient is discharged from skilled nursing facility care and then readmitted to the same facility within three days or less after the discharge. It does not matter whether the resident is readmitted from a hospital, from home or from another type of healthcare facility.
The three-day window begins with the calendar day of discharge, and includes the two following calendar days. The resident must return to the same skilled nursing facility by midnight at the end of the third calendar day. If the patient is readmitted within the 3-day window, the variable per diem rate paid for that patient will reset to the day of the discharge, and the patient's assessment schedule will continue as previously set. CMS has clarified that no PPS assessments will be required, including admission or discharge assessments. The IPA assessment will be optional under PDPM. However, OBRA assessment requirements will remain in place and an OBRA discharge would need to be completed. If the patient is readmitted after the 3-day window, the variable per diem rate paid for that patient will reset to Day 1, and a new 5-day assessment will be required, resetting the patient's assessment schedule. The IPA will be optional under PDPM.
When the patient has been admitted to and discharged from a different SNF, there can be no interrupted stay status. The readmission in that case will always be considered a new stay, and will reset the per diem and assessment clock to Day 1.