Understanding the 1135 Waiver and MDS coding for SNFs during COVID-19

  • Impacts of financial decisions
  • 5/20/2020

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During declared public emergencies the Secretary of Health and Human Services (HHS), can enact CMS 1135 waivers for Medicare, Medicaid and CHIP providers to provide relief from restrictions and certain regulations. The 1135 blanket waiver for long-term care facilities or skilled nursing facilities (SNFs) covers aspects of reimbursement, staffing data, staff training and certification, cohorting, physician visits, and Minimum Data Set (MDS) requirements, to name a few. In this video, we review the 1135 waiver aspects that relate to the 3-day prior hospitalization, renewed SNF coverage after having exhausted benefits, cohorting, and the MDS requirements.   

The waiver of the 3-day prior hospitalization requirement will allow for SNFs to put certain patients on Medicare A SNF coverage without having to send them to the hospital for a qualifying stay. The waiver of the benefit period will allow beneficiaries to access additional Medicare A days without needing the 60 day period of wellness under certain conditions. There are also changes to certain aspects of MDS completion and transmission timelines, and changes to the CMS cohorting guidelines that will impact SNFs during the public health emergency.

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