Ending a Benefit Period

10.4.2 - Ending a Benefit Period (Rev. 80, Issued: 10-26-12, Effective: 04-01-13, Implementation: 04-01-13) The benefit period ends with the close of a period of 60 consecutive days during which the patient was neither an inpatient of a hospital nor of a SNF. To determine the 60 consecutive day period, begin counting with the day the individual was discharged. (See §10.4.3.2 of this chapter for determining the end of a benefit period when an individual remains in a SNF.) As noted in section 10.4, the term “benefit period” is synonymous with spell of illness. However, the statutory language (at §1861(a) of the Social Security Act) that describes a benefit period as a “spell of illness” is sometimes misunderstood to mean that a benefit period is linked to a particular medical episode or type of condition, so that the onset of a new and entirely unrelated condition could serve to end a benefit period even in the absence of a 60-day break in the beneficiary’s “inpatient” status. In fact, the onset of a new condition is not, in itself, relevant to the ending of a benefit period, which can occur only through a 60-day break in inpatient status, as described above.