Skilled Nursing Facility (SNF) Care
A skilled nursing facility (SNF) admission is covered when both of the following conditions are met:
- The beneficiary has a qualifying hospital stay of three consecutive days or more, not including the hospital discharge day* and
- The beneficiary enters the SNF within 30 days of discharge from the hospital.
There is no day limit, as long as medical necessity continues. Coverage includes: a semi-private room, regular nursing services, meals including special diets, physical, occupational and speech therapy, medications furnished by the facility, and necessary medical supplies and appliances.
*Effective for SNF admission dates on or after Sept. 3, 2020, the requirement for a qualifying hospital stay of three consecutive days or more is waived for the duration of the President’s national emergency for COVID.
Visit our SNF Reimbursement page for payment information.
All TRICARE beneficiaries* require an approval from Health Net Federal Services, LLC for skilled nursing facility admissions.
Providers must include all applicable clinical information with their approval request.
*Beneficiaries dual eligible for TRICARE and Medicare require an approval on day 101 when TRICARE becomes the primary payer. Requests must be submitted to Wisconsin Physicians Services (WPS) – Military and Veterans Health for review and approval. Visit the WPS website for submission information.