Return to Enrollee’s Home Skilled Nursing Facility (SNF)

10.9 – Return to Enrollee’s Home Skilled Nursing Facility (SNF) (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) An MA plan must provide coverage through a home SNF (defined at 42 CFR §422.133(b)) of post-hospital extended care services to enrollees who resided in a nursing facility prior to the hospitalization, provided: • The enrollee elects to receive the coverage through the home SNF; and • The home SNF either has a contract with the MA plan or agrees to accept substantially similar payment under the same terms and conditions that apply to similar nursing facilities that contract with the MA plan. This requirement also applies if the MA plan offers SNF care without requiring a prior qualifying hospital stay. The post-hospital extended care scope of services, cost-sharing, and access to coverage provided by the home SNF must be no less favorable to the enrollee than post-hospital extended care services coverage that would be provided to the enrollee by a SNF that would be otherwise covered under the MA plan (42 CFR §422.133(c)). In a PPO, in- network cost-sharing applies.