Situations in Which a SNF ABN Is Not Needed to Transfer

70.3 - Situations in Which a SNF ABN Is Not Needed to Transfer Financial Liability to the Beneficiary (Rev.: 4198; Issued: 01-11-19; Effective: 04-30-18; Implementation: 04-30-18) SNFs need not issue a SNF ABN to transfer financial liability to the beneficiary: • If the extended care item or service is not a Medicare benefit (e.g., personal comfort items excluded under §1862(a)(6)). • If a beneficiary is being furnished post-hospital extended care services while a resident in a SNF and payment is expected to be denied for an otherwise Medicare covered benefit because it does not meet a technical benefit requirement (e.g., SNF stay not preceded by the required prior three-day hospital stay or the beneficiary is exhausting his/her 100 benefit days). • If Medicare is expected to deny payment for Part B covered medical and other health services which the SNF furnishes, either directly or under arrangements with others, to an inpatient of the SNF, where payment for these services cannot be made under Part A (e.g., the beneficiary has exhausted his/her allowed days of inpatient SNF coverage under Part A in his/her current spell of illness or was determined to be receiving a non-covered level of care). • If the SNF will not furnish the extended care items or services. A SNF must not give a beneficiary a SNF ABN and then refuse to furnish extended care items or services even though the beneficiary elects to receive these items or services by selecting Option 1, as this is equivalent to the prohibited practice of the SNF pre-selecting Option 2 (not to receive items or services) on a SNF ABN. This rule also applies when the beneficiary agrees with the triggering event (i.e., terminating therapy) and the beneficiary will not be receiving the extended care items or services. NOTE: This rule is not applicable in the situation where the beneficiary elects to receive extended care items or services but refuses to sign the SNF ABN attesting to being personally and fully responsible for payment, in which case, the SNF may then consider not furnishing the specified items or services. • For Medicare Advantage (Part C) enrollees nor for non-Medicare patients because it is to be used solely for individuals enrolled in the Medicare FFS program (Parts A and B). • When extended care items or services are reduced or terminated in accordance with a physician’s order, where a physician does not order the items or services at issue, or where the physician agrees in writing with the SNF’s, the UR entity’s, the QIO’s, or the Medicare contractor’s assessment that the extended care items or services are not necessary. • For swing-bed determinations. The Preadmission/Admission HINN (HINN 1) should be given. NOTE: An ABN, Form CMS-R-131 may be required if a SNF has been acting as a supplier of Part B services or supplies outside a physician’s plan of care. See Section 50 of this manual, as applicable.