TRICARE follows Medicare requirements for admission to a Skilled Nursing Facility (SNF). For admission to be covered, the beneficiary must have a qualifying hospital stay of at least three consecutive days (not including the hospital discharge day) and be admitted to the SNF within 30 days of hospital discharge.
Effective October 1, 2019, TRICARE adopted the Medicare Interrupted Stay Policy. Medicare defines an interrupted stay as one in which a beneficiary is discharged from a SNF and readmitted to the same SNF during the interruption window, which is a three-day period beginning on the first non-covered day following a SNF stay and ends at 11:59 PM on the third consecutive non-covered day. If these conditions are met, the subsequent stay is considered a continuation of the previous “interrupted” stay for the purposes of both the variable per diem and assessment schedules.
If the beneficiary is readmitted to the same SNF outside the interruption window or to another SNF, regardless of the length of time between stays, the Interrupted Stay Policy does not apply, and the subsequent admission will be considered a “new stay.” In this case, the variable per diem schedule will reset to Day 1 payment rates, and the assessment schedule will reset to Day 1, which will necessitate a new five-day assessment.
See the TRICARE Reimbursement manual, Chapter 8, Section 2 for more information.
