The question for the day, lol. I have a resident that came back in after a 90 day hospital stay, has been in and about about a dozen times. He has had a PEG for a while, not sure how long. He was medicaid on his last admission. His HIQA shows 10 days left. Since I've been back in the MDS world I've heard that having 26% or more of your caloric intake from a G tube doesn't automatically disqualify you from recieveing another 100 days of Medicare coverage for another skilled need anymore. Is this true?
I've got a call in to our medicare guru, but haven't heard back from her yet. And if it is still like it was 5 years ago (that G tube residents can never be skilled medicare again) how come this residents HIQA is showing 10 days? Any ideas?
Oh, BTW, this resident does have a new skilled need, unrelated to the tube feeding. He is going to be recievieng IV ABTs x 30 days.
Jul 6, '09
Hi, thanks! Even though this was almost as confusioning! The main thing is that it remains if you continue to remain in SNF bed and recieve a skilled service with no 60 day spell of wellness, you don't get a new medicare period. Including 26% of calories and 501cc fluid daily or up..............right?
This is what I'm taking from the previous thread, and what I got from reading the new regs that came out in 2006. Didn't think things had changed so dramatically in the 4-5 years I've been out of LTC!
Jul 6, '09
re: "...if you continue to remain in snf bed and recieve a (daily)
skilled service with no 60 day spell of wellness, you don't get a new medicare period"
if a person has no daily skilled service for 59 days, then
- goes to the hospital er and receives a blood transfusion and returns, or
- gets im antibiotics for 3 days then switches to p.o., or
- requires q 6 hr catheterization for 3 days (bladder retention due to a drug)
you have to re-start the count all over again.