Since becoming a Next Generation ACO in 2017, KHP Care Managers have seen success with the CMS Skilled Nursing Facility 3-Day Waiver. The waiver allows Medicare patients aligned to a KHP (or other participating NGACOs) admission to approved SNFs from their home, a physician’s office, observation status in an emergency room, or from a hospital stay fewer than three days.
Signature South in Louisville was recently recognized by KHP for their proactive role in verifying Next Gen patients and successfully admitting them from the St. Mary & Elizabeth Hospital emergency department. So far, the process has been smooth and resulted in improved patient satisfaction.
Beneficiaries cannot reside in a nursing home or long term skilled nursing facility, and must be medically stable. In addition, the patient’s must have confirmed diagnoses not requiring further testing or hospital treatment, and must have identified needs that cannot be provided on an outpatient basis or through home health services. Placement can only be in a skilled nursing facility with a star rating of three or higher.