More patients given Medicare benefits for nursing home care after COVID-related hospitalization mandate waived


Center for Infectious Disease Research and Policy.

By Mary Van Beusekom, MS.

A study of US skilled nursing facility (SNF) care for 4.3 million Medicare fee-for-service beneficiaries reveals that the proportion of those who received benefits without a preceding 3-day hospitalization rose from 3% to 18% from 2020 to 2021.

The Harvard Medical School-led study used Medicare fee-for-service claims and the Minimum Data Set for 4,299,863 Medicare beneficiaries reimbursed for SNF care before (January 2018 to February 2020) and during the first 1.5 years of the COVID-19 pandemic (March 2020 to September 2021). The research was published yesterday in JAMA Internal Medicine.

When the COVID-19 public health emergency (PHE) was declared in March 2020, Medicare waived its requirement that beneficiaries have a 3-day hospital stay before receiving SNF benefits.

Overall SNF spending remained stable

From 2020 to 2021, the use of acute-care waivers increased from 3% to 18%. Among long-term care (LTC) residents, waivers climbed from 4% to 49%, with 62% of episodes provided for COVID-19 patients. SNFs in the top quartile of waiver episodes were more often for profit (80% vs 68%) and had lower quality ratings (average overall star rating, 2.7 vs 3.2; average staffing rating, 2.5 vs 3.0) than other SNFs.

Monthly Medicare SNF care spending was $2.1 billion before the pandemic, compared with $2.0 billion during the PHE. Among LTC residents, monthly SNF spending rose from $301 million to $585 million, while hospitalization costs stayed relatively stable.

For [long-term care] residents, the waiver was applied primarily for COVID-19 care, suggesting the waiver’s successful implementation.

“Although the effect of the waiver cannot be differentiated from that of the pandemic, overall SNF care costs did not increase substantially; for LTC residents, the waiver was applied primarily for COVID-19 care, suggesting the waiver’s successful implementation,” the authors wrote.

In a related commentary, Vincent Mor, PhD, of Brown University, said it might be time to rethink the 3-day hospitalization rule. “Almost all Medicare Advantage plans have dropped it, largely because with their existing utilization review processes they are able to deflect hospital admissions and have greater flexibility in reimbursing NHs [nursing homes] for their SNF-supported stays, all of which translates into savings for them,” he wrote.