I am going to have a knee replacement next month and hope that I can get post-operative care in a skilled nursing facility. I’ve heard that Medicare beneficiaries like me haven’t been able to get admitted into skilled nursing facilities. Am I missing something?
It’s Not a Limp, It’s A Swagger
You are right. For too many years, Medicare beneficiaries with bleeding disorders found it hard or impossible to access care in skilled nursing facilities (SNFs). That is because Medicare, by law, reimbursed SNFs on a bundled, daily rate for patient stays. The bundled payment was not high enough to cover the costs of medication used to control bleeding in a person with a bleeding disorder. As a result, most SNFs did not admit people with bleeding disorders due to the significant losses that the SNF would incur in meeting those individuals’ treatment needs.
The good news is that a legislative fix was included in a December 2020 law, thanks to years of continued advocacy on the part of the bleeding disorders community. The Hemophilia Skilled Nursing Facilities Access Act allows SNFs to bill Medicare separately for clotting medications that are administered to patients with bleeding disorders. This eliminates the reimbursement gap that previously made it hard or impossible for Medicare-enrolled bleeding disorders patients to access care in SNFs. The law went into effect on October 1, 2021.
Thanks to the new law, reimbursement issues shouldn’t bar you from access to an SNF for post-operative care. You will, of course, still have to meet clinical criteria for admission to an SNF. As always, if you encounter difficulties in accessing appropriate care, please inform your HTC or other treaters and the national bleeding disorders organizations, so we can work to identify and help navigate any barriers.