[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR409.30]

[Page 221-222]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 409--HOSPITAL INSURANCE BENEFITS--Table of Contents
 
      Subpart D--Requirements for Coverage of Posthospital SNF Care
 
Sec. 409.30  Basic requirements.


    Posthospital SNF care, including SNF-type care furnished in a 
hospital or CAH that has a swing-bed approval, is covered only if the 
beneficiary meets the requirements of this section and only for days 
when he or she needs and receives care of the level described in 
Sec. 409.31. A beneficiary in an SNF is also considered to meet the 
level of care requirements of Sec. 409.31 up to and including the 
assessment reference date for the 5-day assessment prescribed in 
Sec. 413.343(b) of this chapter, when assigned to one of the Resource 
Utilization Groups that is designated (in the annual publication of 
Federal prospective payment rates described in Sec. 413.345 of this 
chapter) as representing the required level of care. For the purposes of 
this section, the assessment reference date is defined in accordance 
with Sec. 483.315(d) of this chapter, and must occur no later than the 
eighth day of posthospital SNF care.
    (a) Pre-admission requirements. The beneficiary must--
    (1) Have been hospitalized in a participating or qualified hospital 
or participating CAH, for medically necessary inpatient hospital or 
inpatient CAH care, for at least 3 consecutive calendar days, not 
counting the date of discharge; and
    (2) Have been discharged from the hospital or CAH in or after the 
month he or she attained age 65, or in a month for which he or she was 
entitled to hospital or CAH insurance benefits on the basis of 
disability or end-stage renal disease, in accordance with part 406 of 
this chapter.

[[Page 222]]

    (b) Date of admission requirements.1 (1) Except as 
specified in paragraph (b)(2) of this section, the beneficiary must be 
in need of posthospital SNF care, be admitted to the facility, and 
receive the needed care within 30 calendar days after the date of 
discharge from a hospital or CAH.
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    1 Before December 5, 1980, the law required that 
admission and receipt of care be within 14 days after discharge from the 
hospital or CAH and permitted admission up to 28 days after discharge if 
a SNF bed was not available in the geographic area in which the patient 
lived, or at the time it would be medically appropriate to begin an 
active course of treatment, if SNF care would not be medically 
appropriate within 14 days after discharge.
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    (2) Exception. A beneficiary for whom posthospital SNF care would 
not be medically appropriate within 30 days after discharge from the 
hospital or CAH may be admitted at the time it would be medically 
appropriate to begin an active course of treatment.

[48 FR 12541, Mar. 25, 1983, as amended at 51 FR 41338, Nov. 14, 1986; 
58 FR 30666, 30667, May 26, 1993; 62 FR 46025, Aug. 29, 1997; 63 FR 
26307, May 12, 1998; 64 FR 41681, July 30, 1999]