On Monday, January 30th we received notice President Biden ended the PHE set to expire on May 11th, 2023, a month beyond the required 60-day notice. With each extension, we’ve discussed that the required 3-day hospital stay and telehealth provisions were tied to the PHE as well as several states’ Medicaid enhancements.
What now?
- We need to ensure our teams are reminded of the rules surrounding the required 3-day hospital stay (observation days and emergency department visits are not included).
- Other Medicare considerations to review include:
- Spell of illness
- Determination of qualified skilled stays
- Technical requirements for Medicare admission
- Telehealth provisions by therapists in the SNF setting have been extended through December 31, 2024, providing relief and access to care for many.
- Now is the time for advocacy within each state in regard to Medicaid reimbursement.
Resources available to support your team:
- Medicare Publication 100-02 – Chapter 8 is the ‘rulebook’
- The official White House Statement of Administration Policy (SAP)
- CMS’ blog – Creating a Roadmap for the End of the COVID-19 Public Health Emergency
- QRM MDS and Medical Review team members are available for in-depth discussions, education tools and resources to support and strengthen your team members.
So the point is: With the PHE ending and the resulting changes, we need to ensure our team members who are new to the industry or have not had the opportunities to navigate the world we will be facing as of May 12th, are prepared and supported to avoid reimbursement and medical review risks.
Please let us know if we can be of help. For more information on access to QRM’s MDS Clinical Reimbursement and Medical Review team members, please reach out to us.
