Post-acute care also includes skilled nursing facility (SNF) care—the most common source of post-acute care for beneficiaries. The following sections provide greater detail on Medicare SNF eligibility, SNF services, and the SNF prospective payment system (PPS). Eligibility for SNF Care

To be eligible to receive Medicare Part A SNF coverage, a beneficiary must have had an inpatient hospital stay of at least 3 consecutive calendar days (not including the day of discharge) and must be transferred to a participating SNF, usually within 30 days after discharge from the hospital. In addition, Medicare requires SNFs to provide services for a condition the beneficiary was receiving treatment for during his or her qualifying hospital stay (or for an additional condition that arose while in the SNF). Covered SNF Services and Providers

A Medicare beneficiary who qualifies for SNF coverage is entitled to up to 100 days of covered SNF care per spell of illness. Part A provides payment for daily skilled nursing, daily skilled rehabilitation, medical social services, drugs/biologicals, durable medical equipment, and bed and board when receiving such services, among other benefits. In general, nursing and rehabilitation services can be labeled skilled if they (1) require the skills of a health professional (e.g., registered nurse, physical therapist) and (2) are provided by or under the supervision of such personnel. SNFs are more commonly found within urban areas and within long-term care nursing facilities (referred to as freestanding SNFs ). 105-33 ) required most SNFs to be reimbursed under a prospective payment system (PPS) beginning on July 1, 1998. For the first 20 days of a Medicare-covered SNF stay, no beneficiary copayment is required. For the 21 st through the 100 th day, a daily copayment, indexed annually at one-eighth (12.5%) of the current Part A inpatient hospital deductible, is required. In 2016, the daily SNF copayment is $161. For each base rate, each RUG will have a noncase-mix component and a nursing component. For the most part, the global per diem rate and the beneficiary's length of stay in the SNF determine the total reimbursement amount to the SNF for the stay. SNF Value-Based Purchasing Program

Section 215 of the Protecting Access to Medicare Act (PAMA; P.L.
A Medicare skilled nursing facility (SNF) is an institution, or distinct part of an institution (e.g., building, floor, wing), that provides post-acute skilled nursing care and/or skilled rehabilitation services, has in effect a written agreement to transfer patients between one or more hospitals and the SNF, and is certified by Medicare. In general, skilled nursing and rehabilitative care are services ordered by a physician that require the skills of professional personnel (e.g., registered nurse, physical therapist) and are provided under the supervision of such personnel. Over 95% of SNFs are within long-term care facilities (or nursing homes).
A Medicare beneficiary is entitled to 100 days of SNF care for each Medicare-covered SNF stay. To be eligible for SNF coverage, a Medicare beneficiary must have been an inpatient of a hospital for at least 3 consecutive calendar days and transferred to a participating SNF usually within 30 days after discharge from the hospital. Beneficiaries must also receive treatment at the SNF for a condition they were receiving treatment for during their qualifying hospital stay (or for an additional condition that arose while in the SNF). For beneficiaries who meet these requirements, Medicare Part A may provide up to 100 days of coverage for the SNF stay.
Under Medicare Part A, SNFs are reimbursed under a prospective payment system (PPS), which began on July 1, 1998. The SNF PPS provides payment for bed and board, nursing care, therapy services, drugs, durable medical equipment, and certain ancillary services under a bundled per diem "per day" reimbursement amount, rather than Medicare paying for each item or service individually. For the first 20 days of SNF coverage, Medicare beneficiaries have no copayment. Medicare beneficiaries have a daily SNF copayment for the 21st through the 100th day indexed annually at one-eighth (12.5%) of the current Part A deductible. For 2016, the daily copayment is $161.
This report describes in further detail the Medicare SNF benefit and its resident population, covered SNF services and providers, and the SNF PPS. In addition, this report describes the Skilled Nursing Facility Value-Based Purchasing Program—a quality-based payment policy change included in the Protecting Access to Medicare Patients Act (PAMA; P.L. 113-93)—and other post-acute care reform efforts.