US · guidance
CMS Pub. 100-02, ch. 8, § 20.3.1.2
Readmissions and Transfers
When determining if the beneficiary was admitted prior to the imposition of the ban, the
actual status of the beneficiary rather than the primary payor is the determining factor.
Therefore, there may be situations where the beneficiary is a private pay patient or a dual
eligible who was receiving Medicaid benefits prior to the imposition of the payment ban.
If this private pay patient or dual eligible goes to the hospital for needed care, and meets
the Medicare Part A criteria upon return to the SNF, the readmission is exempt from the
denial of payment sanction.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c408398e97dbaaa9251da3037551839f91386a06bcc3c711906dc61628deabf9
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