Short-term care in Skilled Nursing Facilities (SNF), Medicare and VA benefits

SNF sounds like Sniff—-Ommmmm….Sniff Sniff

I’m left with more questions after looking into this but here goes. Short-term care is defined as 90-100 days or under. Medicare Part A (Hospital) stops paying for care at SNFs at day 101 and beyond:

For Medicare, you pay

Days 1–20: $0 for each benefit period in 2013.
Days 21–100: $148 coinsurance per day of each benefit period in 2013.
Days 101 and beyond: You are personally liable for ALL costs.

Looking at some information on the Medicare website, I see lots of gotchas. You need a qualifying 3-days (in a row) inpatient hospital stay, not observation (inpatient) stays which are considered outpatient days. Got that? Orwellian to be sure. Oh, and you have to stay out of the hospital or SNF for 60 days to have the benefit period renew.

The VA has about 132 nursing home units but also contracts with with “Community Nursing Homes” (CNH) for short-term rehab and long-term care.

The VA charges this after 21 days:

Inpatient: Up to $97 per day (Community Living (Nursing home), Respite, Geriatric Evaluation)

**Copayments for Long-Term Care services start on the 22nd day of care during any 12-month period — there is no copayment requirement for the first 21 days. Actual copayment charges will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC.

That’s cheaper than the cost of non-VA nursing care charges according to a U. S. News article if you are in a higher Priority Group or run out of Medicare benefits.

According to Medicare Manual (50.1.1), VA enrolled veterans–with dual Medicare/VA eligibility–have an advantage if they need therapy in a non-VA SNF.

The VA may authorize up to six months of care in non-VA SNFs for veterans requiring such care after transfer from a VA hospital. Services furnished pursuant to a VA authorization do not count against the 100 days of extended care benefits available in a benefit period. Where a veteran remains in a SNF until VA benefits are exhausted, extended care benefits could begin under Medicare. Such benefits begin with the first day after the VA benefits are exhausted, provided a physician certifies that the individual still requires skilled nursing care on a continuing basis for a condition for which the patient received inpatient hospital services or which arose while the patient was still being treated in the facility for such a condition. The 3-day qualifying hospital stay and 30-day transfer requirements of the law must be met as of the time of entrance to the facility….

Generally it is advantageous for Medicare beneficiaries who are veterans to have items and services paid for by the VA where possible, since in most cases the VA has no deductible or coinsurance requirements. Also, services paid for in full by the VA do not count against the individual’s maximum number of benefit days or visits available in a Medicare benefit period.

For veterans who do have a VA co-pay, this is also good to know:

NOTE: Medicare can reimburse veterans for (or credit toward Medicare deductible or coinsurance amounts) VA copayment amounts charged for VA authorized services furnished by non-VA sources.

The VA website is vague on details because VA social workers have to get involved and more involved financial information is required.

My late father suffered a major stroke in his seventies. After his hospitalization, he was moved to a skilled nursing facility until all of his Medicare and “MediGap” benefits were exhausted (about three months). Then, ready or not, he was transferred into my mother’s unskilled hands and the semi-skilled hands of home health aides. He still needed therapy services. However, when he used up his allotted time at the SNF, he had to first be re-admitted to a hospital as an inpatient. To accomplish this, my assertive mother had to gain a physician’s cooperation. My mother constantly battled with Medicare over it’s restrictive rules. Dad made progress, used a walker, but aphasia prevented him from conversing. He lived ten more years.

Eligible veterans have more options. Suppose a veteran (dual-enrolled) found himself in bad straights and needing rehab five days a week. What should he do? It would be probably be less expensive to get transferred to a VA hospital, and then placed in a contracted “Community Nursing Home” with therapy services. You can also request the VA pay for a different SNF/CNH if you have a preference. If more rehab is needed later, one can tap into Medicare benefits when (or if) the VA benefits run out.

This VA health benefits calculator “HB Explorer” may shed some light on this matter for individual veterans. Click on “nursing home placement” link after making all entries. http://hbexplorer.vacloud.us/

This brief video (right menu) “Choosing Short-Term Care” impressed me with the importance of visiting SNFs before you need them–especially those with VA contracts. Medicare has a nifty Nursing Home Compare online app.. http://www.medicare.gov/nursinghomecompare/search.html

I entered my zip and up popped 12 local nursing homes (showing several categories with 1-5 stars). I could then compare any three and drill down for more gory details. Most enlightening.