Covered Extended Care Services

50 - Covered Extended Care Services (Rev. 1, 10-01-03) A3-3133, SNF-230 Patients covered under hospital insurance are entitled to have payment made on their behalf for covered extended care services. Payment may be based on reasonable cost or be under the SNF Prospective Payment System (see §10). The facility may charge the beneficiary for services they request that are not included in the PPS rate or otherwise covered by Medicare (i.e. extra meals for family members). An inpatient is a person who has been admitted to a skilled nursing facility or swing bed hospital for bed occupancy for purposes of receiving inpatient services. A person is considered an inpatient if formally admitted as an inpatient with the expectation that they will remain at least overnight and occupy a bed even though it later develops that they can be discharged and do not actually use a bed overnight. NOTES: 1. Custodial care (see Medicare Benefit Policy Manual, Chapter 16, “General Exclusions from Coverage,” §110) is not a covered extended care service. 2. When patients requiring inpatient hospital services occupy beds in a SNF, they are considered inpatients of the SNF. In such cases, the services furnished in the SNF may not be considered inpatient hospital services, and payment may not be made under the program for such services. Such a situation may arise where the SNF is a distinct part of an institution the remainder of which is a hospital, and either there is no bed available in the hospital, or for any other reason the institution fails to place the patient in the appropriate bed. The same rule applies where the SNF is a separate institution. For the same reason, where patients who require extended care services occupy beds in a hospital, payment cannot be made on their behalf for the services furnished to them in the hospital, unless the services are extended care services furnished pursuant to a swing bed approval. (See Medicare Benefit Policy Manual, Chapter 1, “Inpatient Hospital Services,” §10.) 3. When patients who require SNF services are placed in a noncertified part of an institution which contains a participating “distinct part” SNF, the services may be paid under certain conditions, based on the limitation of liability provisions. (See Medicare Claims Processing Manual, Chapter 30, “Limitation of Liability,” §10.4.) The extended care services in §§50.1 - 50.9, below, are covered under hospital insurance.