Ask the Experts, News, Skilled Nursing Facility

Ask the Expert: 100 days benefit

Q: If a resident uses their part of their 100 day benefit for a G-Tube, can we ever skill him again?

 

A: If a resident with a G-Tube goes 60 consecutive days without a hospital stay or any skilled service or skilled care (less than 26% of the calories goes through the tube or less than 50% and less then 501 cc of fluid), then the patient would qualify for a new 100 day benefit period. A few examples of how a person with a G-Tube could requalify for a new 100 days includes:

 

1.  The beneficiary is discharged to home and is not rehospitalized for 60 days.

2. The beneficiary is weaned below the skilled criteria for 60 consecutive days and there is not a hospitalization or other skilled care delivered during the 60 consecutive days.

 

However, if the beneficiary is always tube fed at or above the skilled criteria, then they never have the 60 day break in service and therefore cannot requalify for a new 100 days.

 

The 2 key questions to ask:

 

1.  Did the resident go 60 consecutive days without receiving a skilled service or skilled care?

 

2.  Did the resident go 60 consecutive days without a hospitalization?

 

If you can answer YES to both questions, then the resident would qualify for a new benefit period.