CMS Pub

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www.medicare.gov/nhcompare

KNOW YOUR RIGHTS

If you’re getting Medicare-covered services from a SNF, you may have the right to a fast appeal (also called an “expedited review” or an “immediate appeal”) if you think your Medicare-covered services are ending too soon. During a fast appeal, an independent reviewer called a Quality Improvement Organization (QIO) looks at your case and decides if your health care needs to be continued.You have the right to be included in decisions about your care, the right to a fair process to appeal decisions about payment of services, and the right to privacy and confidentiality. For more information, read the free booklet “Your Medicare Rights and Protections,” visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

WHERE CAN I GET MORE INFORMATION?

You can view or print Medicare publications and fi nd helpful phone numbers and websites by visiting www.medicare.gov or calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. • To learn more about Medicare eligibility, coverage, and 

cost information, read the free booklet “Medicare Coverage of Skilled Nursing Facility Care.” 

• For free health insurance counseling and personalized 

help with insurance questions, call your State Health Insurance Assistance Program (SHIP). 

To fi nd and compare skilled nursing facilities in your area, 

visit www.medicare.gov and select “Nursing Home Compare.” You can find a list of all the nursing homes in your area and 

general information about every Medicare and Medicaidcertified nursing home in the country. It includes nursing home inspection results, the number of nursing staff, and resident information. Call the nursing home to find out if it provides skilled care.

CENTERS FOR MEDICA
w w w . m e d i c 

S K I L L E D N U R S I N G FAC I L I T Y C A R E AND MEDICARE

LET’S GET STARTED.

1 - 8 0 0 - M E D I C A R E

Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. A Skilled Nursing Facility (SNF) could be part of a nursing home or hospital. Generally, Medicare covers skilled care only for a short time after you get out of the hospital.Medicare doesn’t cover custodial care if it is the only kind of care you need in a SNF. Custodial care is care that helps you with usual daily activities like getting in and out of bed, eating, bathing, dressing, and using the bathroom.

M E D I C A R E W I L L C O V E R S K I L L E D C A R E O N LY I F A L L O F T H E FOLLOWING ARE TRUE:

• You have Medicare Part A (Hospital Insurance) and have 

days of SNF coverage left in your benefit period. You get 

100 days of SNF coverage per benefi t period.

• You have an inpatient stay of 3 consecutive days or more 

(a “qualifying stay”), counting the day of inpatient admission to the hospital, but not the day of discharge, before being admitted to the SNF.

• The SNF is certified by Medicare.• You begin getting covered care in the SNF within a short 

time (generally, 30 days) after discharge from the qualifying 3-day hospital stay.

• Your doctor has ordered the services you need for SNF 

care. These services must meet the following criteria:

– Require the skills of professional personnel– Be needed on a daily basis– Be a type of care that can be provided only in a SNF 

on an inpatient basis

– Be needed for a “hospital-related condition” (that 

is, one of the conditions that was treated during the qualifying 3-day hospital stay, even if not the main reason for that stay), or be needed for a condition that arose in the SNF while you were being treated there for a hospital-related condition 

– Be reasonable and necessary

WHAT’S COVERED

Medicare covers the following s• Semi-private room• Meals• Skilled nursing care• Physical therapy• Occupational therapy• Speech-language pathology • Medical social services• Medications• Medical supplies and equipm• Ambulance transportation (

endangers health) to the neathat aren’t available at the SN

• Dietary counseling