Tube Feeding & 60 day spell of wellness

edhcinc...not to belabor this topic but this just came up for discussion in my company. So if I interpret your message correctly if a patient requires primary TF or other examples we've run into: SP cath, chronic wound care, etc.,(which they've used up 100-days) it doesn't matter that they revert to custodial care versus going "home" (outside of the SNF), if they remain in the SNF and acquire a "new" condition (pneumonia) they still are not eligible to receive Part A skilled when returned to the SNF?

Hi. (do not mean to "scream" with the CAPITALS or bold below...)

RE: primary TF or other examples we've run into: SP cath, chronic wound care, etc.,(which they've used up 100-days)

• SP cath IS NOT necessarily skilled care
• YES--Chronic stage 3 or 4 daily wound care in a SNF facility or hospital and using SNF MED A 100 days
• YES--Primary TF performed by staff

RE: it doesn't matter that they revert to custodial care versus going "home" (outside of the SNF)

• How are you defining "custodial care"? NON-SKILLED CARE?? If a person is in a MC or Medicaid certified bed after using 100 days of SNF MED A benefits and continues to receive daily skilled care (and this could be tricky...TF for 30 days--then d/c'd, an IM injection day 31 thru 41, IV antibiotics days 42 thru 52, etc) the person cannot break the "spell of illness" until he/she does NOT receive a skilled service (or hospitalization) for 60 consecutive days.
  
• If the person is placed in a NON-CERTIFIED bed or goes home and stays home for 60 consecutive days, he/she is entitled to a new spell of illness--100 more MC A SNF days--following a 3 day inpatient hospitalization.

RE: if they remain in the SNF and acquire a "new" condition (pneumonia) they still are not eligible to receive Part A skilled when returned to the SNF?

• YES--CORRECT--if he/she had continued to receive a daily skiulled service or had no 60 day break in skilled/hospital care.

If you need more help, please e-mail me privately!
Good luck!