SNP After 100 Days on Medicare

[somarco]

I have a client who will most likely go into a memory care SNF in the near future. Her daughter has POA and is handling the finances and decisions about care.

Original Medicare has a 100 day limit for SNF care. Daughter has been told by the facility that, once she hits her 100 day limit she should apply for an SNP plan so mom can start a new 100 days of benefit.

That just doesn't sound right but figured I would bounce this off the SNP brainiacs and see what they say.

I know that a beneficiary MAY be able to qualify for a new benefit period but the process is a bit convoluted and may require readmission to a hospital before going back to the SNF . . . and I presume the SNP will have similar provisions.

 

[yankee466]

I have a client who will most likely go into a memory care SNF in the near future. Her daughter has POA and is handling the finances and decisions about care.

Original Medicare has a 100 day limit for SNF care. Daughter has been told by the facility that, once she hits her 100 day limit she should apply for an SNP plan so mom can start a new 100 days of benefit.

That just doesn't sound right but figured I would bounce this off the SNP brainiacs and see what they say.

I know that a beneficiary MAY be able to qualify for a new benefit period but the process is a bit convoluted and may require readmission to a hospital before going back to the SNF . . . and I presume the SNP will have similar provisions.

So...the 100 day rule is only if you continue to show progress to Medicare standards. If its a memory care issue, there likely is no cure, and also no way to spend three days in the hospital to even qualify for the SNF.

If its your client, I'll assume she is on a Med Sup.

Unless this is potentially a medicaid client with a DSNP, it's one more case of someone who should have called me for Long Term Care insurance years ago.

 

[rmhaire]

Daughter has been told by the facility that, once she hits her 100 day limit she should apply for an SNP plan so mom can start a new 100 days of benefit.

That's the easy part.

After her 100 days is up, she has to sit out 60 days before she can reapply. She also has to meet the 3 day hospital stay before she reapplies.

Medicare will still pay during her 60 day time-out. Just not for the SNF.

 

[somarco]

So...the 100 day rule is only if you continue to show progress to Medicare standards. If its a memory care issue, there likely is no cure, and also no way to spend three days in the hospital to even qualify for the SNF.

If its your client, I'll assume she is on a Med Sup.

Unless this is potentially a medicaid client with a DSNP, it's one more case of someone who should have called me for Long Term Care insurance years ago.

You pretty much confirmed what I was thinking.

She will most likely go into memory care based on the anticipated diagnosis . . . waiting on results now. No cure and most likely, no progress unless one of the new "miracle drugs" is approved and affordable.

Daughter asked about Medicaid and I sent her the qualifying link. Based on limited conversation, I don't think she will qualify (income and assets probably over the limit).

Looks like MA/SNP plan means more OOP for the 100 day stay and little likelihood of anything beyond that.

I also told daughter it was too late for Medicaid planning (putting assets in a trust) and too late to apply for LTCi.

That's the easy part.

After her 100 days is up, she has to sit out 60 days before she can reapply. She also has to meet the 3 day hospital stay before she reapplies.

Medicare will still pay during her 60 day time-out. Just not for the SNF.

I looked thru the Medicare book on home health/SNF care and especially the "in and out" applications (pgs 13 - 17) and pretty much figured out chances are slim for getting coverage beyond 100 days.

https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf

Just hoping there is something I missed but it does not seem that way.

thx for the replies.

 

[Northeast Agent]

[EXTERNAL LINK] - Resources for Georgia Seniors & Their Families

 

[rmhaire]

Just hoping there is something I missed but it does not seem that way.

Since your client's daughter has POA, I'd suggest that she start researching nursing homes that have a memory ward. Some do and some don't.

Then, she needs to have her mother's social security check directed to her. The nursing home is going to try to strong arm her in having it sent directly to them. The daughter needs to pay the nursing home.

The daughter needs to go ahead and apply for Medicaid. Then she needs to move into spend-down mode. This is the part that scares most people but it's not as bad as it was a few years ago.

As for miracle drugs that's not going to happen. Even if they had one it would be unaffordable. I remember when my wife took Aricept and Namenda years ago. My cost was just under a thousand a month OOP.

As for missing anything, you did not.

 

[somarco]

Since your client's daughter has POA, I'd suggest that she start researching nursing homes that have a memory ward. Some do and some don't.

Then, she needs to have her mother's social security check directed to her. The nursing home is going to try to strong arm her in having it sent directly to them. The daughter needs to pay the nursing home.

The daughter needs to go ahead and apply for Medicaid. Then she needs to move into spend-down mode. This is the part that scares most people but it's not as bad as it was a few years ago.

As for miracle drugs that's not going to happen. Even if they had one it would be unaffordable. I remember when my wife took Aricept and Namenda years ago. My cost was just under a thousand a month OOP.

As for missing anything, you did not.

POA for medical and financial decisions.

Joint owner/co-signer for bank account. Will SSA direct deposit into an account that is not the Medicare beneficiary?

She is exploring Medicaid options now.

She is also trying to figure out which Medicare benefits her mom may qualify for . . . I avoid answering those questions and suggest it is not up to her or me to decide. The attending is the one who should assess the situation and code the claim accordingly.

The dementia Rx solution was mostly a pipe dream . . .

Truth is, MOST medication, not just for cognitive decline, cures nothing. It may make life more tolerable, but not a cure.

Even the hail Mary drugs for terminal patients MAY extend life for a few months (average is 2 - 3) at best.

 

[rmhaire]

Joint owner/co-signer for bank account. Will SSA direct deposit into an account that is not the Medicare beneficiary?

SSA will send it to whatever account she provides. Quite common. But the account she has will work fine.

I forgot to mention that she should also start the guardianship process. Much more than POA. She'll need an attorney for this. In Georgia, that'll be a hearing before the probate judge.

When I applied for guardianship for my wife my lawyer forgot to tell me that I'd be served papers like a regular lawsuit. A couple of weeks later there was a knock at my door. When I opened it, there was a sheriff's deputy serving me papers. When he read his cover sheet to me he was quite shocked when I started laughing. When he asked why I was laughing, I said that he'd just named me as both the plaintiff and the defendant. It's not every day some dumb-ass sues himself.

 

[somarco]

I said that he'd just named me as both the plaintiff and the defendant

So . . . did you win? Did you have to hire two attorneys? One to sue you and the other to defend?

 

[rmhaire]

So . . . did you win? Did you have to hire two attorneys? One to sue you and the other to defend?

Nah. Tried to settle out of court but the other guy was such a hard ass.

As far as attorneys, mine went with me but he mostly slept through the hearing. My wife had her own attorney. For real. The probate court appoints an attorney to represent the affected party ... my wife. I never knew that.