What is the discharge process from a SNF

The discharge process can be initiated by your loved one’s Interdisciplinary Team (IDT) for several reasons. 

• When a resident has fully rehabilitated to their prior level of function, the IDT determines that skilled services are no longer necessary and they are safe for discharge.
• If a patient fails to make progress from week to week, Medicare may consider establishing a new baseline, requiring patients to demonstrate gains in some form each week for skilled services to continue. Discharge will be initiated if progress continues not to be made.
• In some cases, residents may be discharged from skilled services without reaching their baseline if their insurance allows for continued therapy at home. 
• If a patient refuses too many therapy sessions. 

When your loved one’s interdisciplinary team (IDT) has determined it’s time for them to be discharged, the facility will provide your loved one with a Notice of Medicare Non-Coverage (NOMNC) form. This form means Medicare will not continue covering the cost of their stay. 

Medicare mandates a minimum of 48 hours’ notice prior to discharge from the Last Covered Date (LCD), providing a 72-hour window before discharge. 

Want to appeal?

Discharge can be appealed during this 72-hour window. If successful, services will continue; otherwise, any days past the discharge date will incur billing for services. Learn more about appealing a discharge here: How Do I Appeal my Discharge from a SNF

If your loved one needs medical equipment…

Upon discharge, discussions regarding ordering durable medical equipment based on medical necessity will take place. Medicare does not cover bathroom items or transport wheelchairs, but the SNF can assist in finding rental options. Selection of a home health company for 8 weeks of in-home therapy, covered by Medicare, is also necessary. 

Getting home

Residents are responsible for arranging transportation home, though private transport options may be available through the skilled nursing facility. 

What happens on the discharge date?

On the discharge date, residents will sign for medications and receive any remaining doses along with instructions for administration. All belongings must be signed for, as anything not listed will not be covered for replacement by the facility. After signing discharge forms, residents are free to leave.

Even after your loved one has left the facility, they can still call with any questions or concerns.