Medicare Shared Savings Program - Skilled Nursing Facility 3-Day Rule Waiver - Guidance Document - February 2018 Version 5

Sep 16, 2026

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Guidance document detailing policies for the waiver of the Skilled Nursing Facility (SNF) 3-Day Rule available to Track 3 Medicare Shared Savings Program Accountable Care Organizations (ACOs) and ACOs in the Medicare ACO Track 1+ Model. Covers background on the SNF 3-Day Rule, waiver eligibility for beneficiaries and SNF affiliates, beneficiary protections including a 90-day grace period, and processes for applying for the waiver. Includes requirements for SNF affiliate lists, agreements, communication plans, Medicare claims processing, public reporting, and compliance.

LanguageEnglish

CategoryLetters

FormatPDF

Pages21

Reading Time7 min

AccessFree to download

Important Notice

Table of Contents

1 Executive Summary

2 Introduction

2.1 Statutory & Regulatory Background

3 SNF 3-Day Rule Waiver Overview

3.1 Background on the SNF 3-Day Rule

3.2 Overview of the SNF 3-Day Rule Waiver

3.3 Applying for a SNF 3-Day Rule Waiver

4 SNF 3-Day Rule Waiver Eligibility

4.1 Beneficiary Eligibility for the SNF 3-Day Rule Waiver

4.2 SNF Eligibility for the SNF 3-Day Rule Waiver

4.3 Beneficiary Protections and 90-Day Grace Period

5 SNF Affiliate List

5.1 SNF Affiliate List Requirements

5.2 SNF Affiliate List Data Validation Tools

6 SNF Affiliate Agreements

6.1 SNF Affiliate Agreement Requirements

6.2 Executed SNF Affiliate Agreement Requirements

7 ACO and SNF Affiliate Communication Plan

8 SNF 3-Day Rule Waiver Medicare Claims Processing

9 SNF 3-Day Rule Waiver Beneficiary Communications

10 SNF 3-Day Rule Waiver Public Reporting Requirements

11 SNF 3-Day Rule Waiver Compliance

Appendix A

Medicare Shared Savings Program SKILLED NURSING FACILITY 3-DAY RULE WAIVER Guidance Document February 2018 Version \#5 Revision History | VERSION | DATE | REVISION/CHANGE DESCRIPTION | AFFECTED AREA | | --- | --- | --- | --- | | 1 | 04/2016 | Initial creation of the final document. | All | | 2 | 06/2016 | Updated the SNF Affiliate Agreements, and added requirements in Section 9. | Section 5 ; Section 9 | | 3 | 12/2016 | Updated document for clarification and formatted into new template. | All | | 3 | 06/01/2017 | Updated to include coverage of the Medicare ACO Track 1+ Model and added new sections. | All; Sections 4 , 8 , 9 , and 10 | | 4 | 08/01/2017 | Added link to the SNF Affiliate Agreement template. | Section 6 | | 4 | 08/01/2017 | Updated the 2018 SNF Affiliate List Review Schedule. | Table 1 | | 5 | 12/14/2017 | Updated to reflect the 2018 Physician Fee Schedule final rule (82 FR 53371) . | Section 2 | | 5 | 12/14/2017 | Revised consistent with the final rule (82 FR 53371) removing reference to ACOs submitting SNF affiliate star-rating documentation. | Section 5.2.2 | | 5 | 12/14/2017 | Removed SNF Affiliate Change Request Review Schedule and added clarifying language on change requests. | Formerly Table 1, Section 5.1.2 | | 5 | 01/11/2018 | Added information about the transition to anew electronic management system. | Important Notice | Table of Contents Important Notice ............................................................................................................ 1 1 Executive Summary ........................................................................................... 2 2 Introduction......................................................................................................... 3 2.1 Statutory & Regulatory Background ............................................................ 3 3 SNF 3-Day Rule Waiver Overview ..................................................................... 4 3.1 Background on the SNF 3-Day Rule ........................................................... 4 3.2 Overview of the SNF 3-Day Rule Waiver..................................................... 4 3.3 Applying for a SNF 3-Day Rule Waiver........................................................ 5 4 SNF 3-Day Rule Waiver Eligibility ..................................................................... 6 4.1 Beneficiary Eligibility for the SNF 3-Day Rule Waiver.................................. 6 4.2 SNF Eligibility for the SNF 3-Day Rule Waiver ............................................ 7 4.3 Beneficiary Protections and 90-Day Grace Period ...................................... 7 5 SNF Affiliate List ................................................................................................. 8 5.1 SNF Affiliate List Requirements ................................................................... 8 5.1.1 SNF Affiliate List Review Cycle ............................................................. 9 5.1.2 SNF Affiliate List Change Request Process ........................................ 10 5.2 SNF Affiliate List Data Validation Tools ..................................................... 11 5.2.1 Verifying Medicare Enrollment ............................................................ 11 5.2.2 CMS 5-Star Quality Rating System ..................................................... 11 6 SNF Affiliate Agreements ................................................................................ 11 6.1 SNF Affiliate Agreement Requirements ..................................................... 12 6.2 Executed SNF Affiliate Agreement Requirements ..................................... 14 7 ACO and SNF Affiliate Communication Plan ................................................. 14 8 SNF 3-Day Rule Waiver Medicare Claims Processing................................... 15 9 SNF 3-Day Rule Waiver Beneficiary Communications .................................. 16 10

FAQs

Who is eligible to use the SNF 3-Day Rule waiver under this guidance?

The waiver is available to Track 3 Medicare Shared Savings Program Accountable Care Organizations (ACOs) and to ACOs participating in the Medicare ACO Track 1+ Model.

What system transition and blackout period affects SNF affiliate list change requests?

CMS targets April 2, 2018 for launch of the new ACO Management System (ACO-MS). ACOs use HPMS until March 2, 2018 for SNF affiliate list change requests and will not access HPMS or ACO-MS from March 3, 2018 to April 1, 2018.

What is included in the document regarding waiver administration?

It outlines waiver eligibility and beneficiary protections, the SNF affiliate list and data validation tools, SNF affiliate agreements, an ACO/SNF communication plan, Medicare claims processing, beneficiary communications, public reporting, and compliance.

Sep 16, 2026

Upload by Jacob