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A skilled nursing facility (SNF) is designed to provide short-term care for people who no longer need acute care in the hospital but are not well enough to go home. Under TRICARE, a SNF must have the staff and equipment to provide skilled nursing, skilled rehabilitation or other medically necessary health care services, including prescription medications.
For TRICARE to cover SNF admission, beneficiaries must:
• Be treated in a hospital for at least three consecutive days, not including the day of discharge; and
• Be admitted within 30 days of your hospital discharge (with some exceptions) to a skilled nursing facility.
In addition, the doctor’s treatment plan must demonstrate a need for medically-necessary rehabilitation and skilled services. Also, the facility must be Medicare-certified and have a participating provider agreement on file with TRICARE.
Under skilled nursing care, TRICARE typically covers the following:
• Medically necessary skilled nursing care
• Rehabilitative (physical, occupational and speech) therapies
• Room and board
• Prescribed drugs
• Laboratory work
• Supplies
• Appliances
• Medical equipment
TRICARE beneficiaries are responsible for cost shares. The amount beneficiaries pay varies, depending on their eligibility status and TRICARE option. For more information, see the chart at www.tricare.mil/costs.
If a beneficiary is Medicare and TRICARE eligible:
• For days 1 to 20, Medicare pays 100 percent
• For days 21 to 100, Medicare covers all costs, except for the required Medicare copayment. TRICARE covers the copayment
• After day 100, TRICARE is the primary payer and the beneficiary pays TRICARE beneficiary cost shares.
SNFs will have to preauthorize care provided to Medicare-eligible TRICARE beneficiaries once Medicare benefits are exhausted and TRICARE becomes the primary health coverage.
TRICARE and Medicare do not cover long-term care. Long-term care includes support services for beneficiaries with a degenerative condition (Parkinson’s, stroke), a prolonged illness (cancer) or cognitive disorder (Alzheimer’s).
Beneficiaries needing additional information regarding Medicare benefits can contact the Social Security Administration, toll-free at (800) 772-1213. Additional Medicare information is available at www.medicare.gov.
Related Article:
Preauthorization Now Required for Skilled Nursing Facility Care
www.tricare.mil/pressroom/news.aspx?fid=638
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