General Information: 314.996.7020 | 844.996.7020

Skilled Nursing Facility Waiver

New Ruling Allows BJC ACO to Directly Admit Patients to a Skilled Nursing Facility

Thanks to a new ruling, physicians who participate in the BJC Accountable Care Organization (ACO) are now able to directly admit their ACO Medicare patients into an approved skilled nursing facility to continue their recovery. Normally, Medicare patients are required to have a three-day inpatient hospital stay prior to transferring to a skilled nursing facility for therapy services.

The ruling that began in 2017 allows ACO physicians to admit ACO patients to an approved skilled nursing facility from the patient’s home, the physician’s office, from an emergency room or from the hospital, even when they don’t have a three-day inpatient stay.

Only skilled nursing facilities that have received three or more stars under the CMS Five-Star Nursing Home Quality Rating System were approved to affiliate with BJC ACO for patients’ care. BJC has affiliation agreements with 31 facilities to ensure patients have a choice and continue to receive excellent care.

To be eligible, Medicare patients must not already live in a long-term care or skilled nursing facility and must also meet the following criteria:

  • Be medically stable
  • Have a confirmed diagnosis
  • Must not require inpatient hospital evaluation or treatment
  • Have an identified skilled nursing or rehabilitation need that cannot be provided on an outpatient basis or through home health services

Patients still have the option to go to a skilled nursing facility that is not affiliated with the ACO; however, normal Medicare requirements will apply, including the requirement for a three-day inpatient hospitalization. 

To determine if a patient is eligible for an ACO SNF waiver, contact the care management team at 314.996.7020 or toll-free 844.996.7020.

Download the Patient Information Handout here >>