Skilled Nursing Facility Requirements For Admission


For those transitioning from hospital to home following an illness, injury, or surgery, a skilled nursing facility can help speed up recovery and ease the shift back to independent living. However, not everyone needs a skilled nursing facility, and to be eligible for Medicare coverage, a patient must meet specific criteria for admission. Read on to find out if you or your loved one qualifies for skilled nursing care.

What is a skilled nursing facility?

Skilled nursing facilities are residential centers that provide round-the-clock nursing and rehabilitative services to patients on a short-term or long-term basis. Examples of the services provided at a skilled nursing facility include wound care, medication administration, physical and occupational therapy, and pulmonary rehabilitation.

Generally, patients who are admitted to skilled nursing facilities are recovering from surgery, injury, or acute illness, but a skilled nursing environment may also be appropriate for individuals suffering from chronic conditions that require constant medical supervision. If you or a loved one is interested in using Medicare for skilled nursing, though, the federal government has issued specific skilled nursing facility requirements for admission.

What are the eligibility requirements for admission to a skilled nursing facility?

Medicare will cover admission to a skilled nursing facility if:

  • You have Medicare Part A (hospital insurance) with days left in your benefit period. A benefit period begins the day you’re admitted to a hospital or a skilled nursing facility and ends 60 days after the end of your stay.

  • You have a qualifying hospital stay. This generally means you must have experienced at least three inpatient days in a hospital.

  • Your doctor believes you require skilled nursing care on a daily basis. This care must be given under the supervision of skilled nurses and therapists and must be directly related to a condition treated during your qualifying hospital stay.

  • You are admitted to a skilled nursing facility that is certified by Medicare. A skilled nursing facility must meet strict criteria to maintain their Medicare certification.

What skilled nursing services are covered by Medicare?

Once you are admitted to a skilled nursing facility, the following services covered by Medicare include, but are not limited to:

  • A semi-private room, shared with other patients

  • Meals and nutritional counseling

  • Skilled nursing care

  • Rehabilitative services related to your health goals, such as physical therapy, occupational therapy, speech therapy, and respiratory therapy

  • Medication

  • Medical social services

  • Medical supplies

  • Limited ambulance transportation

In general, Medicare will cover up to 100 days of treatment in a skilled nursing facility. It’s important to note that if you ever refuse your daily skilled care or therapy while in a facility, you may be denied coverage for the rest of your stay. Following doctors’ orders is the best way to ensure continued Medicare coverage – and to ensure a full recovery.

How do I find a Medicare-certified skilled nursing facility?

Medicare maintains a public list of certified skilled nursing facilities, including their state inspection reports, quality measures, staffing levels, and resident characteristics. The US Department of Health’s Centers for Medicare and Medicaid Services (CMS) also provides a rating system to help prospective patients compare the quality of care and customer service offered at different skilled nursing facilities in their area. A facility can get between one and five stars; a five-star rating is considered excellent.

Bella Vista Health Center is a 5-star skilled nursing facility in San Diego

If you or a loved one is in need of short-term rehabilitative care, Bella Vista Health Center has some of the highest quality skilled nursing San Diego can provide. We’re proud to maintain a five-star rating from CMS, offering each of our patients individualized care in a comfortable, nurturing environment.

Call (619) 644-1000 to find out more about our facility and our services.