SNF 100 Days Reset To Day 1 On New MA ?

[yogooglethis]

I received a call from son of lady who is currently on day 33 in a skilled nursing facility following a stroke.They expect her to be in SNF possibly another 20-40 days.The son is freaking out because she has only medicare and is have to pay the SNF co pay after day 20.She cant qualify for med supp because of recent IP stay but she could get an MA plan because she has a sep for LIS.The SNF is in network and the MA plan SNF benefit is:

0 copay day 1-20
160 21-40
0 41-100


putting the issue continuity of care because of prior authorizations etc. that are involved with ma plans aside for a moment does any body know if the SNF benefit period would reset to day 1 if she enrolled in new ma paln for 1/1/17 or would pick up where she left off on original medicare on 1/1/17 which would be day 41?

 

[G.Gordon]

I'm betting not. That is a continuous benefit period.

No clear facts on this, just my educated guess.

 

[Todd King]

I received a call from son of lady who is currently on day 33 in a skilled nursing facility following a stroke.They expect her to be in SNF possibly another 20-40 days.The son is freaking out because she has only medicare and is have to pay the SNF co pay after day 20.She cant qualify for med supp because of recent IP stay but she could get an MA plan because she has a sep for LIS.The SNF is in network and the MA plan SNF benefit is:

0 copay day 1-20
160 21-40
0 41-100


putting the issue continuity of care because of prior authorizations etc. that are involved with ma plans aside for a moment does any body know if the SNF benefit period would reset to day 1 if she enrolled in new ma paln for 1/1/17 or would pick up where she left off on original medicare on 1/1/17 which would be day 41?

The plan would only start paying on 1/1/17, so no, it won't reset.

 

[NIAMAN]

Sorta like those calls you get- "My Dentist says I need some major dental work. Do you carry Dental Insurance ?"

 

[yogooglethis]

The plan would only start paying on 1/1/17, so no, it won't reset.

So you are saying if they were on day 40 on original medicare on 12/31/16 they would be at day 41 on 1/1/17 when the new ma plan starts? This is not something i would recommend because of continuity of care issues etc. but I was asked the question by the client because the ma plan has 0 co pay for days 41 -100 and just curious as to how this would actually work.

 

[kstein]

The MAPD probably would not pre approve the extra days anyways. I find MAPD plans rarely pre approve care for more than a week at most.
Back when UOO had GI plan N this situation made me look like a rock star.

I get calls from clients and referrals a lot about the hmo/PPO plan not letting a person stay for very long. Then you also have the admissions at the facility telling the patient to get off Med Adv as well..

 

[goillini52]

The MAPD probably would not pre approve the extra days anyways. I find MAPD plans rarely pre approve care for more than a week at most.
Back when UOO had GI plan N this situation made me look like a rock star.

I get calls from clients and referrals a lot about the hmo/PPO plan not letting a person stay for very long. Then you also have the admissions at the facility telling the patient to get off Med Adv as well..

What do you mean it made you look like a rock star? MOFO wouldn't have started paying on day 41, or any other day of that claim. GI doesn't mean they'll start paying on a SNH claim already in progress. After that stay is over, yes.

 

[kstein]

I'm pretty sure I had clients pick up sups mid stay and be covered for the copays from day 21-100 but it's been a few years so I'm not 100% sure, although most were introduced to me while in the hospital prior to the nursing home and had straight medicare or an MAPD that was balking at approving any skilled care.

I recently had this happen and sent the gal to Transamerica via the NRA for a sup. Not sure if she got her parents covered but that was the only option I could think of.

 

[goillini52]

I'm pretty sure I had clients pick up sups mid stay and be covered for the copays from day 21-100 but it's been a few years so I'm not 100% sure, although most were introduced to me while in the hospital prior to the nursing home and had straight medicare or an MAPD that was balking at approving any skilled care.

I recently had this happen and sent the gal to Transamerica via the NRA for a sup. Not sure if she got her parents covered but that was the only option I could think of.

Well, I'm sure that they wouldn't have picked up a SNH claim mid stay, or hospital stay for that matter. Wish they would.

 

[kstein]

What makes you say that, since the claim is based off of the admin date? Maybe because they got the supp before they entered the facility, made the facility claim covered but not the Part A deductible?