Implementing the 3-Day Skilled Nursing Facility Waiver: Key Insights

IntroductionThe Centers for Medicare & Medicaid skilled nursing facility (SNF) 3-day waiver permits patients attributed to an Accountable Care Organization (ACO) to be admitted to an SNF or transitional care unit from an emergency department, outpatient setting, inpatient stay (<3 days), or observational status without Medicare's requisite 3-day inpatient stay.MethodsOur institution's ACO implemented the waiver program in 2023. We report our experience with implementing the waiver and describe benefits and barriers, as well as interventions developed, outcomes achieved, and opportunities presented for patients and health care facilities.ResultsThrough a streamlined process, patients can more readily access essential care, and health care facilities benefit from enhanced efficiency. Furthermore, the ACO can more effectively manage health care utilization and cost. Although the program offers benefits to patients, their families, and health care facilities, implementing and maintaining the program has challenges, with barriers including underdeveloped workflows, gaps in staff education and communication, difficulties in patient identification, and challenges with specific facility requirements.ConclusionsThe SNF 3-day rule waiver has been valuable in enhancing patient care and optimizing health care delivery within our ACO. Ongoing efforts to refine processes and address challenges will further improve the program's effectiveness and sustainability.