General Rules

70.1 - General Rules (Rev. 767, Issued: 12-02-05, Effective: N/A, Implementation: N/A) A SNF whose provider agreement terminates or that is denied payment for new admissions as an alternative to termination for noncompliance with one or more requirements for participation, may only be paid for covered Part A inpatient services under the following conditions: Termination (Voluntary or Involuntary) • Payment can continue to be made for up to 30 days for covered Part A inpatient services furnished on and after the effective date of termination for beneficiaries who were admitted prior to the termination date. EXAMPLE: Termination date: 9/30/86 o Beneficiary admitted: before 9/30/86 o Payment can be made: from 9/30/86, up to and including 10/29/86 Denial of Payments for New Admissions (DPNA) • Payment can continue to be made for covered Part A inpatient services furnished on or after the effective date of denial of payments for beneficiaries who were admitted before the effective date of denial of payments. EXAMPLE: Denial of payment date: 9/30/86 o Beneficiary admitted before: 9/30/86 o Payment can be made: Indefinitely For detailed instructions on SNF payment bans, or denial of payment for new admission see IOM 100-04, Chapter 6, section 50. NOTE: An inpatient, who goes on leave from the SNF before or after the effective date of denial of payments for new admissions is not considered a new admission when returning from leave.