Medicare Coverage In A Skilled Nursing Facility

What is a Skilled Nursing Facility? (SNF)

The New York State Veterans' Home is a Skilled Nursing Facility that specializes in skilled care. The facility has staff to provides skilled nursing care within the categories of rehabilitation services such as Physical Therapy, Occupational Therapy, and Speech Therapy.

What are the Guidelines for Coverage in a Skilled Nursing Facility?

  • Skilled service for persons 65 years of age or become entitled to health insurance benefits.
  • Admission to a hospital, the qualifying hospital stay must be "medically necessary".
  • Hospital stay must be 3 (three) consecutive days, not counting day of discharge.
  • Admission to a SNF within 30 days after discharge from a hospital stay, which included at least 3 consecutive days.

Definition of "Covered Level of Care"

Care in an SNF is covered if all of the following factors are met:

  • Requires skilled nursing services or skilled rehabilitation services. (i.e. services must be performed by or under the supervision or a professional or technical personnel) (See sections 214.1-214.3) and)
  • Requires skilled services on a daily basis (see 214.5) Complete Guide to Medical Coverage Issues, March 2001.
  • What if my care is not considered skilled care?
  • Medicare A does not pay for services that are custodial. During the Admission process payment source is determined at that time. Custodial care is primarily for the purpose of helping with daily living activities or meeting personal needs, provided by staff without professional skills or training. Therapy may also be provided, however, may be considered to be maintenance therapy and is not covered by Medicare A.

Medicare information:

Empire Blue Cross Medicare Services

Beneficiary Inquiry Department
P.O. Box 4846
Syracuse, New York 13221-4846


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