Silver State ACO, through its participation in the MSSP Enhanced Track, is eligible to utilize the SNF Three-Day Waiver Program provided very specific criteria are met.
The SNF Three-Day Rule Waiver program waives the requirement for a three-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries.
In order to be eligible to receive covered SNF services under the waiver, a beneficiary must be currently attributed to Silver State ACO. Additionally, beneficiaries must meet the following requirements:
- Not reside in a SNF or other long-term care setting
- Be medically stable
- Not require inpatient or further inpatient hospital evaluation or treatment
- Have certain and confirmed diagnoses
- Have an identified skilled nursing or rehabilitation need that he or she cannot receive as an outpatient
- Have been evaluated and approved for admission to the SNF within three days prior to the SNF admission by an ACO provider/supplier that is a physician, consistent with the ACO's beneficiary evaluation and admission plan.
Eligible beneficiaries will be referred to affiliated SNFs which have contracted with Silver State ACO to participate in the SNF Three-Day Waiver program. The referral for SNF Three-Day waiver admission can be initiated by outpatient ACO physicians, emergency departments, observation/short stay and inpatient acute care settings. The requesting entity must contact Silver State ACO’s Care Management Partner, USHS at 833-208-0588, to assist in the review of eligibility and direction on the process to admit under the SNF Three-Day Rule Waiver program.
Below are relevant forms and a link to Arkos Health website.
SNF 3 Day Waiver Process Flow Chart
Silver State ACO Affiliated SNF for 3 Day Waiver
Beneficiary Notice SNF 3 Day Waiver
