Medicare PPS benefits

[Connie L. Frank]

I believe that this is something that has been discussed in the past, but as usual you don’t think you need it until it’s too late so here it goes….   2 questions hopefully this makes sense and you are able to enlighten me further: 1)       a comment was made to me that all individuals have a right to at least 5 days Medicare coverage following a 3 day + hospitalization, including those hospitalized for “psychiatric or dementia” issues -do they not still have to meet the criteria for appropriate RUG level either at the hospital or skilled services by us?   2)       have any of you held individuals following a 3 day + hospitalization for agitated/ aggressive behavior r/t dementia or unstable psych requiring medication adjustment and if so, what criteria do you look for prior to picking up and what guidelines are you using that justify continued skilled services         Is there a detailed reference that I can refer to? ( I apologize in advance, I haven’t pulled out the SNF PPS manual because people “in the know” that are well versed on this issue, have had variations in opinion, so I presume it’s not well spelled out there either!)