Gtube and 60 day wellness rule.

[MDSRN15]

Experts,

One of our consultants informed us that if 100 days of MED A is used to cover a NEW gtube then you cannot use your MED A days again ever. She said that the resident remains skilled and the 60 day wellness rule applies, even if she is stable after 100 days, but still gtube fed.

1. What if the resident goes to the hospital for more than 3 days, can I use her

Med A days?

2. What if the gtube was placed in 2014, does her MED A re-starts again in 2015?

3. What if she came from a different facility and they used her 100 days for the gtube, went to hospital and when we run medicare coverage report another 100 days comes up?

Is the consultant correct?

[Talino]

1. What if the resident goes to the hospital for more than 3 days, can I use her Med A days? -- NO

2. What if the gtube was placed in 2014, does her MED A re-starts again in 2015? -- NO

3. What if she came from a different facility and they used her 100 days for the gtube, went to hospital and when we run medicare coverage report another 100 days comes up? -- NO

As long as the resident is receiving:

• Calories = 51% or more per day or
  
• Calories = 26% to 50% AND 501cc or more of fluids per day
  

... through enteral feeding, the care remains at skilled level. In which case, the resident will never have acquired a 60-day non-skilled level of care.

How to arrive at a non-skilled level of care with tube feeding?

• While at the SNF, the resident must have received below the amount of calories/fluids mentioned above AND must not have been hospitalized for 60 consecutive days, or
  
• The resident was discharged home, been at home while receiving tube feeding AND was never hospitalized for 60 consecutive days.
  

[MDSRN15]

What if we only exhausted 50 days for the new gtube, went out to hospital(more than 3 days) and came back, can we use the other 50 days?

[Talino]

Yes, and a new 3-day hosp. stay is not even required.