Effective Date: January 1, 2016
Previous Policy
Medicare nursing home days:
Medicare will pay (without co-payment) up to 20 days of skilled nursing care following 3 days of hospitalization.
From day 21 to day 100, a co-payment is required. If the member is eligible for QMB it will pay the co-payment.
After day 100, Medicare will not pay any nursing home care.
Medicaid members who are residents of medical institutions may receive Medicare payment for some of the time that they are institutionalized.
Medicaid members under Medicare are still obligated to pay the nursing home the contribution to cost of care.
The nursing home will send any excess money collected to ORS.
The member may request a refund through DHHS. Send a Form 79R to HCF, Office of Coverage and Reimbursement.
Make sure any refund made is considered an asset and that the asset level is not exceeded.