From the Guidelines
Medicare patients can be admitted to rehabilitation facilities directly from home, not just after a hospital stay, as long as they meet specific criteria that justify the need for intensive rehabilitation services. For direct admission from home, the patient must require intensive rehabilitation services that can only be provided in an inpatient setting, have a qualifying medical condition that necessitates rehabilitation, and have a physician certify that this level of care is medically necessary 1. The patient must also need at least two types of therapy (such as physical, occupational, or speech therapy) and be able to participate in at least three hours of therapy five days per week.
Key Considerations
- The patient must be certified as being homebound by a physician to be eligible for home health care agency services, which is defined by the Centers for Medicare & Medicaid Services as unable to leave the home except to receive medical care or to have occasional nonmedical trips 1.
- Home healthcare services are reimbursed under a prospective payment system that covers up to 60 days of services, and these services may be extended if they can be clinically justified 1.
- Comprehensive outpatient rehabilitation facilities offer a range of services, including physician, physical therapy, and social or psychological services, and may also provide occupational therapy, speech-language therapy, respiratory therapy, nursing care, and other services 1.
Criteria for Admission
- The patient must have a qualifying medical condition that necessitates rehabilitation, such as a stroke or other neurological condition 1.
- The patient must require intensive rehabilitation services that can only be provided in an inpatient setting, such as physical, occupational, or speech therapy 1.
- The patient must be able to participate in at least three hours of therapy five days per week, and the therapy must be reasonable and necessary, restorative in nature, and complex and sophisticated enough that it can only be performed safely and effectively by or under the supervision of a qualified healthcare professional 1.
From the Research
Medicare Patient Admission to Rehab
- Medicare patients can be admitted to rehab from home or after a hospital stay, depending on the specific circumstances and eligibility criteria.
- According to 2, the "Extended Care Benefit" or 3-midnight rule, applies to post-acute skilled nursing facilities (SNF) coverage, and patients may be eligible for coverage of skilled nursing or rehabilitation services following a hospitalization.
- The study 2 suggests that case managers should not assume that a patient does not meet the criteria for this benefit and should advocate for deferred admission when the patient is ready.
- However, there is no direct evidence in the provided studies that specifically addresses the admission of Medicare patients to rehab from home.
Eligibility Criteria
- The study 2 mentions that the eligibility of Medicare beneficiaries for the "Extended Care Benefit" may be broader than commonly known by case managers.
- The study 2 also emphasizes the importance of a comprehensive assessment of the patient's continuing care needs and early intervention to determine the possibility of the patient's post-acute needs.
- The 3-midnight rule requires that the patient must have been hospitalized for at least 3 midnights to be eligible for SNF coverage, but there are exceptions and variations in the application of this rule 2.
Wound Care and Rehabilitation
- The studies 3, 4, 5, and 6 focus on wound care and management, but do not directly address the admission of Medicare patients to rehab from home or after a hospital stay.
- These studies highlight the importance of interdisciplinary approaches, patient-centered care, and self-management in wound care, but do not provide specific guidance on Medicare patient admission to rehab.