3-day waiver program

A skilled nursing facility (SNF) is a skilled nursing facility, which may be a nursing home facility or dedicated beds in a hospital. Regular Medicare health insurance will only pay for someone to receive care in a SNF if they have previously been hospitalized in a hospital for a minimum of three days within the last 30 days before being admitted to the SNF.
A SNF 3-day waiver allows a Medicare beneficiary (someone who receives Medicare insurance) to go to a SNF without first having a minimum 3-day stay in a hospital, as long as they meet skilled criteria. That is, a person must require medical or rehabilitative services that cannot be provided in their home or other setting.

If you are a Medicare insurance beneficiary who sees an ACO physician, you are likely to be assigned by Medicare to our ACO and would then be able to use this benefit if you need to.

If you are receiving one of our Keystone ACO newsletters, you are currently assigned to our ACO by Medicare. If you are reading this newsletter but you’re unsure if you are a KACO beneficiary, there’s no need to worry. Your doctors and other ACO providers and care coordinators will let you know and work with you to make arrangements for a SNF 3-day waiver admission, should you ever need one.

The ACO can only use the SNF 3-day waiver at facilities that are of high quality, have contracted the ACO and were approved by Medicare to provide care for our Keystone ACO beneficiaries who qualify for it. A list of current SNFs that have a three-star rating or higher in CMS Nursing Home Compare will provided to each beneficiary at the time of need as part of a Medicare-required letter stating your rights as a Medicare insurance recipient.

Individuals cannot sign up to be in an ACO. Doctors, practitioners and healthcare organizations can contract with Medicare to become an ACO, just as Keystone ACO providers have. Patients can assign themselves to a primary care provider by going to medicare.gov, creating an account and assigning themselves to the main doctor they see for primary care (their family doctor). If that doctor/provider is in an ACO, they will be assigned to the ACO their doctor is contracted with.
For additional questions, contact Keystone ACO or call Medicare at 800-MEDICARE (800-633-4227) 24 hours a day, 7 days a week. TTY users can call 877-486-2048.