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Ask the expert: qualifying stay

Q:What are the rules regarding a qualifying hospital stay at a hospice inpatient facility? Can a stay at a hospice inpatient facility be used as a qualifying hospital stay for a skilled nursing facility?

A: The regulations are pretty clear that the hospice would need to meet the definition of a hospital.  Most inpatient hospice facilities would not meet this definition, therefore, you could not count a 3-day stay in an inpatient hospice unless they met the hospital definition.

100-02 Medicare Benefits Policy Manual, Chapter 8, §20 Prior Hospitalization and Transfer Requirements (last updated 2003)

In order to qualify for post-hospital extended care services, the individual must have been an inpatient of a hospital for a medically necessary stay of at least three consecutive calendar days.  In addition, effective December 5, 1980, the individual must have been transferred to a participating SNF within 30 days after discharge from the hospital, unless the exception in §20.2 applies (30 day transfer).