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.
- Must have administration 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?