In June 2008, the Centers for Medicare & Medicaid Services (CMS) issued guidance that addressed Medicare skilled nursing facility (SNF) benefits’ statutory requirement of a three-day prior hospital stay and the inability of beneficiaries who were evacuated or transferred because of the serious flooding in the states of Iowa and Indiana to meet this requirement. This guidance provided temporary emergency coverage of SNF services that are not post-hospital SNF services under our authority in section 1812(f) of the Social Security Act (the Act), for those beneficiaries who are evacuated, transferred, or otherwise dislocated as a result of the flooding.

In addition, for beneficiaries who, prior to the flooding, had been recently discharged from an SNF after utilizing some or all of their available SNF benefit days, guidance was issued to address the inability to meet the requirement to end an existing Medicare benefit period (or “spell of illness”) before renewing SNF benefits. Under the authority of section 1812(f) of the Act, this policy enabled such beneficiaries to receive up to an additional 100 days of SNF Part A benefits for care needed as a result of the flooding, without first having to end a spell of illness by being discharged to custodial or non-institutional care for a 60-day period.

Unlike the general waivers issued in response to the Iowa and Indiana flooding under the authority of section 1135 of the Act, these two SNF-related policies were not limited to states designated as emergency areas. Rather, they would apply to all beneficiaries who were evacuated from an emergency area because of the flooding, regardless of where the “host” SNF providing post-flood care was located. In addition, these two SNF-related policies would remain in effect until CMS issued a notification that normal procedures would resume.

CMS has terminated these SNF-related policies concurrently with the general flood-related waivers issued under the section 1135 authority, which expire on September 12, 2008. Accordingly, effective with SNF admissions occurring on and after September 13, 2008, the Internet-only manual instructions for determining compliance with the SNF benefits’ prior hospitalization and benefit period requirements shall apply.

Finally, beginning September 13, 2008, all program policies, questions, and answers that implemented modifications to program requirements under the section 1135 waiver authority for the Iowa/Indiana floods are no longer applicable. Therefore, claims with dates of service September 13, 2008, and later will follow all normal program requirements.