484 Backer. Notice of Exclusions from Medicare BenefitsSkilled Nursing Facility (NEMB-SNF) - cms 2025

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Pursuant to Section 1861(i) of the Act, beneficiaries must have a prior inpatient hospital stay of no fewer than three consecutive days to be eligible for Medicare coverage of inpatient SNF care. This requirement is referred to as the SNF 3-Day Rule.
A qualifying inpatient hospital stay means youve been a hospital inpatient for at least 3 days in a row (counting the day you were admitted as an inpatient, but not counting the day of your discharge). Medicare will only cover care you get in a SNF if you first have a qualifying inpatient hospital stay.
You need skilled services for one of these: An ongoing condition that was also treated during your qualifying inpatient hospital stay (even if it wasnt the reason you were admitted to the hospital). A new condition that started while you were getting SNF care for the ongoing condition.
Medicare covers up to 100 days of care in a skilled nursing facility (SNF) for each benefit period if all of Medicares requirements are met, including your need of daily skilled nursing care with 3 days of prior hospitalization. Medicare pays 100% of the first 20 days of a covered SNF stay.
Benefit periods measure your use of inpatient hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row.
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NOTICE OF EXCLUSIONS FROM MEDICARE BENEFITS (NEMB) There are items and services for which Medicare will not pay.
The Medicare Exclusion Database (MED) is the CMS repository and distributor of all Office of the Inspector General (OIG)-sanctioned data.
Many people who qualify for skilled nursing or nursing homes are older adults who are at a higher risk of falls, have chronic conditions, and other health problems that may qualify them. Older adults often benefit from services that can improve their quality of life and ability to carry out activities of daily living.