1. General

Posthospital extended care services represent an extension of care for a condition for which the individual received inpatient hospital services. Extended care services are “posthospital” if initiated within 30 days after discharge from a hospital stay which included at least 3 consecutive days of medically necessary inpatient hospital services. (In certain circumstances the 30 day period may be extended, as described in 2. below.) For SNF admissions occurring after October 29, 1972, but before December 5, 1980, see subsection 4. below.

In determining the 30 day transfer period, the day of discharge from the hospital is not counted in the 30 days. For example, a patient discharged from a hospital on August 1 and admitted to an SNF on August 31 was admitted within 30 days. The 30 day period begins on the day following actual discharge from the hospital and continues until the individual is admitted to a participating SNF, and requires and receives a covered level of care. Thus, an individual who is admitted to an SNF within 30 days after discharge from a hospital, but does not require a covered level of care until more than 30 days after such discharge, does not meet the 30 day requirement. (See 2. below for an exception under which such services may be covered.)

If an individual whose SNF stay was covered upon admission is thereafter determined not to require a covered level of care for a period of more than 30 days, payment could not be resumed for any extended care services they may subsequently require even though they have remained in the facility. Such services could not be deemed to be “posthospital” extended care services. (For exception, see 2. below.)