Skilled Nursing News December 18, 2022
The Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that patients are not inappropriately denied coverage for post-acute care in particular settings — including skilled nursing facilities — by Medicare Advantage organizations (MAOs).
CMS raised the issue as part of a proposed rule issued on Dec. 15, stating that MAOs generally cannot apply coverage criteria that is more restrictive than traditional Medicare coverage, as determined by national coverage determination (NCDs), local coverage determinations (LCDs) and Medicare laws. This also applies to certain “substantive coverage criteria and benefit conditions” that are not governed by an NCD or LCD, including transfers to post-acute settings.
“For example, if an MA patient is being discharged from an acute care hospital...
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