Skilled Nursing Facility (SNF) 3-Day Rule Waiver

Silver State ACO, through its participation in the MSSP Enhanced Track, is eligible to utilize the SNF 3-Day Waiver Program provided very specific criteria are met.

The SNF 3-Day Rule Waiver program waives the requirement for a three-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries.

In order to be eligible to receive covered SNF services under the waiver, a beneficiary must be currently attributed to Silver State ACO. Additionally, beneficiaries must meet the following requirements:

• Not reside in a SNF or other long-term care setting
• Be medically stable
• Not require inpatient or further inpatient hospital evaluation or treatment
• Have certain and confirmed diagnoses
• Have an identified skilled nursing or rehabilitation need that he or she cannot receive as an outpatient
• Have been evaluated and approved for admission to the SNF within three days prior to the SNF admission by an ACO provider/supplier that is a physician, consistent with the ACO's beneficiary evaluation and admission plan.

Eligible beneficiaries will be referred to affiliated SNFs which have contracted with Silver State ACO to participate in the SNF 3-Day Waiver program. The referral for SNF 3-Day waiver admission can be initiated by outpatient ACO physicians, emergency departments, observation/short stay and inpatient acute care settings. The requesting entity must contact Silver State ACO’s Care Management Partner, USHS at 833-208-0588, to assist in the review of eligibility and direction on the process to admit under the SNF 3-Day Rule Waiver program.