{"id":10827,"date":"2020-04-02T09:00:06","date_gmt":"2020-04-02T03:30:06","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=10827"},"modified":"2025-07-09T09:32:58","modified_gmt":"2025-07-09T09:32:58","slug":"skilled-nursing-facility-3-day-rule-waiver","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/skilled-nursing-facility-3-day-rule-waiver\/","title":{"rendered":"Skilled Nursing Facility 3- Day Rule Waiver"},"content":{"rendered":"<p style=\"text-align: justify;\">CMS is waiving the requirement\u00a0<span style=\"box-sizing: border-box; margin: 0; padding: 0; text-align: left;\">in Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF 3-Day Rule Waiver) stay. This provides temporary emergency coverage of SNF services without a qualifying hospital stay for those who need to be transferred as a result <\/span>of a disaster or emergency.<\/p>\n<p style=\"text-align: justify;\">In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first starting a new benefit period. Second, CMS is waiving 42 CFR 483.20 to relieve SNFs on the Minimum Data Set assessments and transmission timeframe requirements.<\/p>\n<h2 style=\"text-align: left;\">Background of Skilled Nursing Facility 3-Day Rule Waiver<\/h2>\n<p style=\"text-align: justify;\">Under the Shared Savings Program, the Centers for Medicare &amp; Medicaid Services (CMS) enters into a participation agreement with each participating Accountable Care Organization (ACO). CMS will reward eligible ACOs when they lower growth in Medicare Parts A and B fee-for-service (FFS) costs (relative to their ACO-specific benchmark) and meet performance standards on quality of care.<\/p>\n<p style=\"text-align: justify;\">The SNF 3-Day Rule Waiver waives the 3-day inpatient hospital stay requirement before a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries. Only Shared Savings Program ACOs currently participating in or applying to certain Shared Savings Program performance-based risk tracks have the opportunity to apply for a waiver of the SNF 3-Day Rule, and they must apply separately for the waiver during the annual application process.<\/p>\n<h3 style=\"text-align: left;\">To apply for an SNF 3-Day Rule Waiver, ACOs must:<\/h3>\n<ul style=\"text-align: justify;\">\n<li style=\"text-align: left;\">Meet specific eligibility criteria;<\/li>\n<li style=\"text-align: left;\">Submit an SNF Affiliate List;<\/li>\n<li style=\"text-align: left;\">Submit sample SNF Affiliate Agreement(s);<\/li>\n<li style=\"text-align: left;\">Complete the SNF Affiliate Agreement table in the ACO Management System (ACOMS);<\/li>\n<li style=\"text-align: left;\">Submit an executed SNF Affiliate Agreement for each proposed SNF affiliate and<\/li>\n<li style=\"text-align: left;\">Submit a communication plan, beneficiary evaluation and admission plan, and a care management plan.<\/li>\n<\/ul>\n<h2 style=\"text-align: center;\"><strong><span style=\"color: #008080;\">Are You Looking For Streamlined <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/skilled-nursing-facility-medical-billing-services.html\">SNF Medical Billing<\/a> Assistance? Then Contact MBC<\/span><\/strong><\/h2>\n<h2 style=\"text-align: left;\">Overview of the Skilled Nursing Facility 3-Day Rule Waiver<\/h2>\n<p style=\"text-align: justify;\">To support ACOs\u2019 efforts to increase quality and decrease costs, CMS finalized a waiver of the SNF 3-Day Rule for eligible ACOs participating in specific performance-based risk initiatives of the Shared Savings Program (\u00a7 425.612). Eligible ACOs may apply for an SNF 3-Day Rule Waiver during their agreement period or at the time of application to participate in the program.<\/p>\n<p style=\"text-align: justify;\">ACOs, including those applying for a waiver during an existing participation agreement term, must follow the annual application process. For PY 2019, SNF 3-Day Rule Waivers are effective beginning July 1 following approval of an SNF 3-Day Rule Waiver Application.<\/p>\n<p style=\"text-align: justify;\">Applications for an SNF 3-Day Rule Waiver in subsequent years will have an effective date of January 1 of the performance year following approval. Once approved, an ACO will maintain its SNF 3-Day Rule Waiver for the remainder of its current participation agreement unless CMS determines it is necessary to revoke the ACO\u2019s waiver as provided in \u00a7 425.612(d)(3) or under the terms of the Track 1+ Model.<\/p>\n<p style=\"text-align: justify;\">Suppose CMS or the ACO terminates the ACO\u2019s participation agreement. In that case, the waiver ends on the date specified by CMS in the termination notice or on the effective date of termination, as defined in the ACO\u2019s advance written notice to CMS required under \u00a7 425.220.<\/p>\n<p style=\"text-align: justify;\">It is important to note that an SNF 3-Day Rule Waiver does not create a new benefit or extend Medicare SNF coverage to patients who could be treated in outpatient settings or who require long-term custodial care. The waiver is intended to provide ACOs participating in certain performance-based risk tracks with additional flexibility to increase quality and decrease costs.<\/p>\n<p style=\"text-align: justify;\">The SNF benefit itself remains unchanged. The SNF 3-Day Rule Waiver only applies to services furnished in SNFs that meet the eligibility requirements in \u00a7 425.612, discussed below in Section 4.<\/p>\n<p style=\"text-align: justify;\">The SNF 3-Day Rule Waiver does not restrict a beneficiary\u2019s choice of provider or supplier. A beneficiary continues to have the option to seek care from any Medicare FFS provider or supplier, including from an SNF or other facility that is not an affiliate of an ACO participating in the Shared Savings Program. In such circumstances, standard Medicare requirements apply, including a 3-day inpatient hospitalization requirement.<\/p>\n<h2 style=\"text-align: left;\">Applying for the Skilled Nursing Facility 3-Day Rule Waiver<\/h2>\n<h3 style=\"text-align: left;\">Necessary steps to apply for an SNF 3-Day Rule Waiver include:<\/h3>\n<ul style=\"text-align: justify;\">\n<li style=\"text-align: left;\">Submit a Notice of Intent to Apply (NOIA) for an SNF 3-Day Rule Waiver.<\/li>\n<li style=\"text-align: left;\">Submit an SNF 3-Day Rule Waiver Application.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Applicants must submit their applications through ACO-MS under the guidance provided on the Application Toolkit webpage. The Shared Savings Program Application Types &amp; Timeline webpage contains an up-to-date list of all applicable deadlines.<\/p>\n<p style=\"text-align: justify;\">ACOs receive multiple requests for information (RFI) notifications summarizing CMS\u2019 review of submitted application information during the application process. ACOs should carefully review the RFIs sent by CMS because they only have a few opportunities to correct deficiencies identified in the submitted application information.<\/p>\n<h2 style=\"text-align: left;\">Skilled Nursing Facility 3-Day Rule Waiver Medicare Claims Processing<\/h2>\n<p style=\"text-align: justify;\">SNF waiver-approved ACOs must comply with all Medicare claims submission requirements, except for a 3-day inpatient hospital stay before a Medicare-covered, post-hospital, extended care service (42 CFR \u00a7 425.612(a)). An SNF 3-Day Rule Waiver does not change FFS billing requirements (other than the 3-day inpatient stay requirement).<\/p>\n<p style=\"text-align: justify;\">SNFs do not include new data elements when submitting FFS claims to indicate their intent to use an SNF 3-Day Rule Waiver. For institutional claims, CMS will set the Demonstration Number field to \u201c77\u201d for claims that meet all of the following conditions:<\/p>\n<ul style=\"text-align: justify;\">\n<li style=\"text-align: left;\">Received\u201d date on the claim is on or after January 1 of the calendar year indicated on the claim\u2019s \u201cFrom\u201d date;<\/li>\n<li style=\"text-align: left;\">A CCN (first 6 digits) is found on the claim that is also found on the ACO\u2019s certified SNF Affiliate List;<\/li>\n<li style=\"text-align: left;\">Beneficiary Health Insurance Claim Number (HICN) found on the claim, which is also found on the ACO\u2019s assignment list;<\/li>\n<li style=\"text-align: left;\">The date of service \u201cFrom\u201d date on the claim is on or after the effective start date of a waiver, and<\/li>\n<li style=\"text-align: left;\">The ACO ID (AXXXX) associated with the SNF affiliate is the same as the ACO ID associated with the eligible beneficiary.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Suppose an SNF claim is rejected exclusively due to a lack of a qualifying hospital stay, meaning all other\u00a0<a href=\"https:\/\/www.medicare.gov\/\" target=\"_blank\" rel=\"noopener\">Medicare<\/a> FFS coverage, claims processing, and other applicable requirements are met. In that case,\u00a0the SNF should verify that the ACO, SNF, and beneficiary meet waiver eligibility requirements under \u00a7 425.612, described above.<\/p>\n<p style=\"text-align: justify;\">Suppose the ACO, SNF, and beneficiary meet these eligibility requirements. In that case, the SNF should contact its MAC to inquire about payment for the claim under the terms of the SNF 3-Day Rule Waiver under the Shared Savings Program. In case of any issues billing for Skilled Nursing Facility Services, contact<strong> MBC<\/strong>\u00a0at <a href=\"tel:888-357-3226\">888-357-3226<\/a>\/ <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com.<\/a><\/p>\n<h2>FAQs:<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1752052291688\"><strong class=\"schema-faq-question\">1. What is the SNF 3-Day Rule Waiver?<\/strong> <p class=\"schema-faq-answer\">The SNF 3-Day Rule Waiver allows for coverage of skilled nursing facility (SNF) services without requiring a prior 3-day hospitalization, especially in emergencies. This provides flexibility for patients needing care after disasters.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752053479869\"><strong class=\"schema-faq-question\">2. Who can apply for the SNF 3-Day Rule Waiver?<\/strong> <p class=\"schema-faq-answer\">Only eligible Accountable Care Organizations (ACOs) participating in specific performance-based risk tracks of the Shared Savings Program can apply for the waiver. They must meet specific criteria and apply.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752053518244\"><strong class=\"schema-faq-question\">3. What documentation is needed to apply for the waiver?<\/strong> <p class=\"schema-faq-answer\">ACOs must submit an SNF Affiliate List, sample agreements, and a communication plan, among other documents. A complete application must be submitted through the ACO Management System (ACOMS).<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752053530576\"><strong class=\"schema-faq-question\">4. Does the waiver change the existing Medicare SNF benefits?<\/strong> <p class=\"schema-faq-answer\">No, the waiver does not create new benefits or extend coverage for those who could be treated in outpatient settings. It only provides additional flexibility for eligible ACOs.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752053541344\"><strong class=\"schema-faq-question\">5. How are claims processed under the SNF 3-Day Rule Waiver?<\/strong> <p class=\"schema-faq-answer\">Claims from waiver-approved ACOs must comply with all Medicare submission requirements, except the 3-day hospitalization rule. Claims will include a specific Demonstration Number to indicate they fall under the waiver.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CMS is waiving the requirement\u00a0in Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF 3-Day Rule Waiver) stay. This provides temporary emergency coverage of SNF services without a qualifying hospital stay for those who need to be transferred as a result of a disaster [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":10834,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[378],"tags":[816,3964,3966,3965,380,382],"class_list":["post-10827","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-snf-billing-services","tag-outsourced-medical-billing-services","tag-skilled-nursing-facility-3-day-rule-waiver","tag-skilled-nursing-facility-3-day-rule-billing","tag-skilled-nursing-facility-3-day-rule-waiver-guidance","tag-snf-billing-2","tag-snfs-medical-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.9 (Yoast SEO v27.9) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Skilled Nursing Facility 3- Day Rule Waiver<\/title>\n<meta name=\"description\" content=\"CMS waives skilled nursing facility 3-day rule for temporary emergency coverage. 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The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/skilled-nursing-facility-3-day-rule-waiver\\\/#faq-question-1752052291688\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/skilled-nursing-facility-3-day-rule-waiver\\\/#faq-question-1752052291688\",\"name\":\"1. What is the SNF 3-Day Rule Waiver?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The SNF 3-Day Rule Waiver allows for coverage of skilled nursing facility (SNF) services without requiring a prior 3-day hospitalization, especially in emergencies. 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