We have been informed of RAC activity in Region A (Performant Recovery, Inc.) for the following states:  Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

RAC Issue in Region B (CGI) for the same issue (SNF Psychiatric Condition) is posted for the following states: Illinois, Minnesota, Wisconsin, Michigan, Indiana, Ohio, and Kentucky.

RAC Issue in Region C (Connolly) for the same issue (SNF Psychiatric Condition) is posted for the following states: Alabama, Arkansas, Colorado, Florida, Georgia Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Territories of Puerto Rico and U.S. Virgin

The focus are patients with a psychiatric condition who transferred from a psychiatric hospital to a SNF.

 

Issue Title
SNF Psychiatric Condition
Number A000602012
Description
Patients with only a psychiatric condition who are transferred from a psychiatric hospital to a participating SNF are likely to receive only non-covered care. Also, patients whose primary condition/needs are psychiatric in nature often require considerably more specialized, sophisticated nursing techniques and physician attention than is available in most participating SNFs. (SNFs primarily engaged in treating psychiatric disorders are precluded by law from participating in Medicare.)
Type of Review Complex
Provider Type Skilled Nursing Facility
States
CT, DC, DE, MD, ME, MA, NY, PA, MD, NJ, RI, VT, NH
Date of Service
Claims having a “claim paid date” which is more than 3 years prior to the ADR date will be excluded.
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Issue Title
Skilled Nursing Facility (SNF) Psychiatric Condition
Number
Description
Patients with only a psychiatric condition who are transferred from a psychiatric hospital to a participating SNF are likely to receive only non-covered care. Also, patients whose primary condition/needs are psychiatric in nature often require considerably more specialized, sophisticated nursing techniques and physician attention than is available in most participating SNFs. (SNFs primarily engaged in treating psychiatric disorders are precluded by law from participating in Medicare.)
Type of Review Complex
Provider Type SNF
States
MN, WI, MI, IL, IN, OH, KY
Date of Service
Dates of Service 10/1/2007–Open
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Issue Title
SNF Level of Care Review
Number C000972013
Description
While a 3-day stay in a psychiatric hospital satisfies the prior hospital stay requirement, institutions that primarily provide psychiatric treatment cannot participate in the program as SNFs. Therefore, a patient with only a psychiatric condition who is transferred from a psychiatric hospital to a participating SNF is likely to receive only non-covered care. In the SNF, the term “non-covered care” refers to any level of care, which is less intensive than the SNF level of care, which is covered under the program.
Type of Review N/A
Provider Type SNF
States
Region C – Novitas
Date of Service
3 years from initial determination date
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Issue Title
SNF Level of Care Review
Number C000982013
Description
While a 3-day stay in a psychiatric hospital satisfies the prior hospital stay requirement, institutions that primarily provide psychiatric treatment cannot participate in the program as SNFs. Therefore, a patient with only a psychiatric condition who is transferred from a psychiatric hospital to a participating SNF is likely to receive only non-covered care. In the SNF, the term “non-covered care” refers to any level of care, which is less intensive than the SNF level of care, which is covered under the program.
Type of Review N/A
Provider Type SNF
States
Region C – Palmetto
Date of Service
3 years from initial determination date
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