In a message dated 11/14/2003 11:09:19 AM Eastern Standard Time, [EMAIL PROTECTED] writes:

I believe that this is something that has been discussed in the past, but as usual you donât think you need it until itâs too late so here it goesâ.

 

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 âpsychiatric or dementiaâ 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 havenât pulled out the SNF PPS manual because people âin the knowâ that are well versed on this issue, have had variations in opinion, so I presume itâs not well spelled out there either!)

Have they read and are they versed in Transmittal 262?  It is clearly defined in there for the meaning of presumed coverage.  If I can find mine, I will send it to you.
 
 
Glenn Gorleski (Barnes) RAC-C
Case Manager, MDS Coordinator
Quality Assurance Nurse

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