US · guidance
CMS Pub. 100-02, ch. 8, § 20.2.2
Medical Appropriateness Exception
A3-3131.3.B, SNF-212.3.B
An elapsed period of more than 30 days is permitted for SNF admissions where the
patient’s condition makes it medically inappropriate to begin an active course of
treatment in a SNF immediately after hospital discharge, and it is medically predictable at
the time of the hospital discharge that he or she will require covered care within a
predeterminable time period. The fact that a patient enters a SNF immediately upon
discharge from a hospital, for either covered or noncovered care, does not necessarily
negate coverage at a later date, assuming the subsequent covered care was medically
predictable.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
400e3621b60555ab9b0c9b958896f034c5a9b855e63509ec23c226ae0d0bbf92
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