100-02 Medicare Benefit Policy Manual: Chapter 8 Crosswalk

Medicare Benefit Policy Manual
Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance
Crosswalk
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Description
8 	10 	A3-3130 	SNF-210 	§1861 of the Act 	Requirements - General
8 	10.1 	A3-3130 	SNF-210 	A-01-122
A-02-096,
A-00-49 DTD
8/00,
§1861 of the Act
Medicare SNF PPS Overview
8 	10.2 	A-98-16 DTD 5/98 	Medicare SNF Coverage Guidelines Under PPS
8 	10.3 	A3-3130.1 	HO-213 	SNF-201.3 	Hospital Providers of Extended Care Services
8 	20 	A3-3131 	SNF-212 	Prior Hospitalization and Transfer Requirements
8 	20.1 	A3-3131.1 	SNF-212.1 	Three-Day Prior Hospitalization
8 	20.1.1 	A3-3131.2 	SNF-212.2 	Three-Day Prior Hospitalization - Foreign Hospital
8 	20.2 	A3-3131.3 	SNF-212.3 	Thirty-Day Transfer
8 	20.2.1 	A3-3131.3A 	SNF-212.3A 	General
8 	20.2.2 	A3-3131.3B 	SNF-212.3B 	Medical Appropriateness Exception
8 	20.2..2.1 	A3-3131.3B1 	SNF-212.3.B1 	Medical Needs Are Predictable
8 	20.2.2.2 	A3-3131.3B2 	SNF-212.3.B 	Medical Needs Are Not Predictable

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8 	20.2.2.3 	A3-3131.3B3 	SNF-212.3B3 	SNF Stay Prior to Beginning of Deferred Covered
Treatment
8 	20.2.2.4 	A3-3131.3B4 	SNF--212.3B4 	Effect of Delay in Initiation of Deferred Care
8 	20.2.2.5 	A3-3131.3B5 	SNF-212.3B5 	Effect on Spell of Illness
8 	20.2.3 	A3-3131.3C 	SNF-212.3C 	Readmission to a SNF
8 	20.3 	A-01-131 	Payment Bans
8 	20.3.1 	Payment Bans on New Admissions
8 	20.3.1.1 	Beneficiary Notification
8 	20.3.1.2 	Readmissions and Transfers
8 	20.3.1.3 	Sanctions Lifted: Procedures for Beneficiaries
Admitted During the Sanction Period
8 	20.3.1.4 	Payment Under Part B During a Payment Ban on New
Admissions
8 	20.3.1.5 	Impact of Consolidated Billing Requirements
8 	20.3.1.6 	Impact on Spell of Illness
8 	30 	A3-3132 	SNF-214 	Skilled Nursing Facility Level of Care - General
8 	30.1 	Administrative Presumption
8 	30.2 	A3-3132.1 	SNF-214.1 	Skilled Nursing and Skilled Rehabilitation Services
8 	30.2.1 	A3-3132.1A 	SNF-214.1A 	Skilled Services Defined

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8 	30.2.2 	A3-3132.1B 	SNF-214.1B 	Principles for Determining Whether a Service is
Skilled
8 	30.2.3 	Specific Examples of Some Skilled Nursing or Skilled
Rehabilitation Services
8 	30.2.3.1 	A3-3132.1C1 	SNF-214.1C1 	Management and Evaluation of a Patient Care Plan
8 	30.2.3.2 	A3-3132.1C2 	SNF-214.1C2 	Observation and Assessment of Patient’s Condition
8 	30.2.3.3 	A3-3132.1C3 	SND-214.1C3 	Teaching and Training Activities
8 	30.2.4 	A3-3132.1D 	SNF-214.1D 	Questionable Situations
8 	30.3 	A3-3132.2 	SNF-214.2 	Direct Skilled Nursing Services to Patients
8 	30.4 	A3-3132.1C 	SNF-214.1C 	Direct Skilled Rehabilitation Services to Patients
8 	30.4.1 	A3-3132.3A 	SNF-214.3A 	Skilled Physical Therapy
8 	30.4.1.1 	A3-3132.3A1 	SNF-214.3A1 	General
8 	30.4.1.2 	A3-3132.3A2 	SNF-214.3A2 	Application of Guidelines
8 	30.4.2 	A3-3132.3B 	SNF-214.3B 	Speech Pathology
8 	30.4.3 	A3-3132.3C 	SNF-214.3C 	Occupational Therapy
8 	30.5 	A3-3132.4 	SNF-214.4 	Nonskilled Supportive or Personal Care Services
8 	30.6 	A3-3132.5 	SNF-214.5 	Daily Skilled Services Defined
8 	30.7 	A3-3132.6 	SNF-214.6 	Services Provided on an Inpatient Basis as a “Practical
Matter”

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8 	30.7.1 	A3-3132.6A 	SNF-214.6A 	The Availability of Alternative Facilities or Services
8 	30.7.2 	A3-3132.6B 	SNF-214.6B 	Whether Available Alternatives Are More Economical
in the Individual Case
8 	30.7.3 	A3-3132.6C 	SNF-214.6C 	Whether the Patient’s Physical Condition Would
Permit Utilization of an Available, More Economical
Care Alternative
8 	40 	A3-3333 	SNF-220 	Physician Certification and Recertification
8 	50 	A3-3133 	SNF-230 	Covered Extended Care Services
8 	50.1 	A3-3133.1 	SNF-230.1 	Nursing Care Provided by or Under the Supervision of
a Registered Professional Nurse
8 	50.2 	A3-3133.2 	SNF-230.2 	Bed and Board in Semi-Private Accommodations
Furnished in Connection With Nursing Care
8 	50.3 	A3-3133.3 	SNF-230.3 	Physical, Speech, and Occupational Therapy Furnished
by the Skilled Nursing Facility or by Others Under
Arrangements With the Facility and Under Its
Supervision
8 	50.4 	A3-3133.4 	SNF-230.4 	Medical Social Services to Meet the Patient’s
Medically Related Social Needs

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8 	50.5 	A3-3133.5,
Rev. A3-1838
dtd 6/01,
A3-3133.5A,
A3-3133.5B,
A3-3133.5C,
A3-3133.5D
SNF-230.5,
SNF-230.5A,
SNF-230.5B,
SNF-230.5C,
SNF-230.5D
Drugs and Biologicals
8 	50.6 	A3-3133.6 	SNF-230.7 	Supplies, Appliances, and Equipment
8 	50.7 	A3-3133.7 	SNF-230.8 	Medical Service of an Intern or Resident-in-Training
8 	50.8 	A3-3133.9 	SNF-230.1 	Other Services
8 	50.8.1 	A3-3133.9A 	SNF-230.10A 	General
8 	50.8.2 	A3-3133.9B 	SNF-230.10C 	Respiratory Therapy
8 	60 	Covered Extended Care Days
8 	70 	A3-3137 	SNF-260 	Medical and Other Health Services Furnished to SNF
Patients
8 	70.1 	A3-3137 	SNF-260C 	Diagnostic Services and Radiological Therapy
8 	70.2 	A3-3137 	SNF-260C 	Ambulance Services
8 	70.3 	SNF-270 	Inpatient Physical Therapy, Occupational Therapy, and
Speech Pathology Services
8 	70.4 	SNF-270.1 	Services Furnished Under Arrangements With
Providers