THofNE ACO 3-Day Rule Waiver

THOfNE 3-Day Rule Waiver

What is the 3-Day Rule Waiver?

  • The SNF 3-Day Rule Waiver waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered SNF stay.
  • The patient must be a Medicare beneficiary and attributed to the THofNE MSSP ACO.
  • Remember, attribution is based on claims not necessarily primary care provider.

Common SNF Waiver Referrals:

  • Falls with non-operative fractures
  • Falls without fractures, but with impaired mobility
  • Respiratory management
  • Infection requiring I.V. antibiotics
  • Post-surgical care

Beneficiary Clinical Eligibility Requirements for SNF Waiver

  • The patient is medically stable, not requiring inpatient level of care
  • The patient cannot be clinically managed at home
  • The patient has a short-term skilled need (i.e. PT, wound management, frequent monitoring by a nurse)
  • The patient has certain and confirmed diagnoses
  • The beneficiary does not reside in a SNF or Long-Term Care facility (LTC)
  • The patient was evaluated and approved for SNF admission no more than 72 hours prior by an ACO provider who is a physician, consistent with the ACO beneficiary evaluation and admission plan.
  • Patient has not been in bundle program in last 90 days and does not have a primary dx that falls in one of the bundle DRGs
Our waiver coordinator will assist you in verifying these requirements

How to make a referral:

Monday-Friday 8 am – 5 pm, excluding holidays:

  1. The MD office will email to make a referral to the waiver program. Please include the First/Last name, DOB, MRN and the clinical reason for STR.
  2. Our Waiver Coordinator will check eligibility and review the patient’s chart to ensure they are attributed and clinically eligible.
  3. If eligible, our Waiver Coordinator will email or FAX a blank W-10 form and a MD attestation form that needs to be completed and returned.
  4. Waiver Coordinator will coordinate placement with the office staff, patient/family and eligible Network SNF.
Please note: The process of placing a patient may take several hours

Benefits to Utilizing 3-Day Waiver​

We have a preferred post-acute network of high-quality Skilled Nursing Facilities (SNF) that have partnered with us to share communication and clinical treatment guidelines to give the patient a better overall care experience

  • Your patient does not have to be sent to the ED, thereby avoiding unnecessary admission.
  • You can send the patient directly from your office or from their homes to a high-quality skilled nursing facility.
  • The SNF will work to successfully transition your patient back home with a follow up appointment to your office within 7-14 days of discharge
  • Our Post-Acute Care (PAC) Coordinator will work with the care team to help manage LOS and execute a safe discharge, as well as follow the patient in the community for 30 days