Medicare and Medicaid programs; benefit period determinations, drug regimen reviews and other technical...

Under the Hospital Insurance Program (Medicare--Part A), payment for covered inpatient hospital and skilled nursing facility (SNF) services is available for a limited number of days during each benefit period or "spell of illness." Current Medicare regulations reflect the statutory provision under section 1861(a) of the Social Security Act (Act) that a beneficiary's benefit period begins on the day he or she is furnished inpatient hospital or SNF services and ends when he or she has not been "an inpatient of a hospital nor an inpatient of a skilled nursing facility" (as defined under sections 1861(e)(1) and (j)(1) of the Act, respectively) for 60 consecutive days. These final regulations: Specify that a beneficiary is an "inpatient" of a SNF and is therefore prolonging a spell of illness in a SNF only if the care received by the beneficiary meets skilled level of care conditions and establish certain presumptions which Medicare intermediaries may use in determining whether skilled level of care conditions have been met during a SNF stay. These regulations also provide that a pharmacist must perform drug regimen reviews in intermediate care facilities (ICFs). In addition Section 405.702 of the regulations is amended to remove certain cross-references that are now outdated and unnecessary.