Insurance Coverage

Traditional Medicare: 3 ICU midnights and/or 96 hours on a ventilator

• It is possible for CSH to accept a Medicare patient without having 3 ICU midnights, on a case-by-case basis. However, this type of patient will need to be reviewed further to see if they qualify for CSH placement.

Commercial/Private: Does not require ICU midnights but does require a pre-certification authorization.

• Typically if a patient has UHC or Humana and needs LTAC for vent weaning, they are required to be on a ventilator for 21 days and have a stable trach for 7 days.

Medicare Replacements: Require 3 ICU midnights and a precertification authorization.

Medicaid: We currently DO accept Georgia Medicaid.

Georgia Medicaid Requirements: Require 3 ICU midnights and a precertification authorization.

WHEN DO YOU REFER A PATIENT TO CSH?

• They are no longer in the crisis intervention state of treatment.
• They have completed their initial diagnostic work-up.
• There are no planned MAJOR invasive surgical procedures.
• The patient has a prognosis of a LONG STAY (Varies by insurance carrier and diagnosis).

Traditional Medicare A & B

• Requires 3 midnights in an ICU bed. (PCU beds may qualify). Does NOT require a prior authorization.
• 0-2 ICU midnights is called IPPS. These referrals can have a maximum LTACH length of stay of 14 days. No expensive skills such as TPN, hemodialysis, ventilators can be accepted. Typical IPPS patients get approved – Inexpensive IV antibiotics with a discharge plan. Must have administration approval.
• 3 or more ICU midnights is an LTACH patient.
• O2 dependent (Vent, NIMV, T-piece)
• IV meds (antibiotics and/or critical drips)
• Feeding Source (TPN or Enteral
• Wound Care
  Hemodialysis/Peritoneal dialysis
• Cost of special equipment (Bari-bed)
• HIV meds – must be brought from home.
  • CAN accept PO Chemo meds
  • CANNOT accept IV Chemo
    Discharge plan/secondary insurance?

2) Medicare Replacements

• Requires 3 midnights in an ICU bed. (PCU beds may qualify). Does require a prior authorization.
• 0-2 ICU midnights is called IPPS. These referrals can have a maximum LTACH length of stay of 14 days. No expensive skills such as TPN, hemodialysis, ventilators can be accepted. Typical IPPS patients get approved – Inexpensive IV antibiotics with a discharge plan. Must have administration approval.
• 3 or more ICU midnights is an LTACH patient.
• O2 dependent (Vent, NIMV, T-piece)
• IV meds (antibiotics and/or critical drips)
• Feeding Source (TPN or Enteral)
  Wound Care
• Hemodialysis/Peritoneal dialysis
• Cost of special equipment (Bari-bed, etc.)
• HIV meds – must be brought from home.
  • CAN accept PO Chemo meds
  • CANNOT accept IV Chemo
• Discharge plan/secondary insurance?

3) Medicaid

• We only accept Georgia Medicaid.
• Requires 3 midnights in an ICU bed. (PCU beds may qualify). Does require a prior authorization.

4) Uninsured/Scholarship

• Needs to meet the same criteria as an “IPPS” referral.
• 0-2 ICU midnights is called IPPS. These referrals can have a maximum LTACH length of stay of 14 days. No expensive skills such as TPN, hemodialysis, and ventilators can be accepted.
• Must have administrator approval.

5) Commercial Policies

• Does NOT require 3 midnights in an ICU bed. Does require a prior authorization.
• Skills Considered:
• O2 dependent (Vent, NIMV, T-piece)
• IV meds (antibiotics and/or critical drips)
• Feeding Source (TPN or Enteral)
• Wound Care
• Hemodialysis/Peritoneal dialysis
• Cost of special equipment (Bari-bed, etc.)
• HIV meds -must be brought from home.
  • CAN accept PO Chemo meds
  • CANNOT accept IV Chemo
• Discharge plan/secondary insurance?
  • DO THEY HAVE SNF BENEFITS IF NEEDED?