New Law Helps Open Skilled Nursing Facilities to Patients

Yedida Y Bogachkov PhD avatar

by Yedida Y Bogachkov PhD |

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Provisions of a new law that went into effect on Oct. 1 allow families affected by hemophilia and other bleeding disorders who are under Medicare to better access skilled nursing facilities (SNFs), the National Hemophilia Foundation (NHF) announced.

This law, known as the Hemophilia SNF Access Act, should rectify the challenges that families have faced with securing treatment, the NHF said in a press release.

Getting this legislation passed was a top foundation priority throughout 2020, which saw the act as essential in helping to ease the financial burden of hemophilia and other inherited bleeding disorders on patients and their families.

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Prior to it being approved as part of the 2021 federal appropriations bill, few SNFs were willing to admit patients with inherited bleeding disorders because the reimbursement from Medicare did not adequately cover the cost of the clotting factor therapies they needed.

Under this law, SNFs can bill separately for hemophilia and other inherited bleeding disorder treatments that are administered to those covered by Medicare, allowing facilities to either provide the treatment themselves or partner with a third party, such as a specialty pharmacy.

Medicare will also be required to adequately reimburse facilities that treat inherited bleeding disorder patients, allowing for stays of up to 100 days (short-term stays) provided the patient meets certain criteria, including a hospital stay of at least three days or 72 hours. According to the NHF, this benefit is likely to be of use following surgery or a prolonged hospital stay.

The bundled payment that SNFs will receive from Medicare includes costs associated with nursing care, therapy components, medications, required supplies, and any necessary equipment, in addition to room and board and administration costs.

“With passage of the Hemophilia SNF Access Act, the SNF will be adequately reimbursed for the costly treatments needed by patients with bleeding disorders, removing a major barrier to SNF care. NHF believes this should be sufficient to alleviate concerns that SNFs have had in accepting bleeding disorder beneficiaries,” the foundation stated on a fact sheet listing the law’s provisions.

In terms of treatment, the law covers a large range of therapies used by people with inherited bleeding disorders, in addition to clotting factors.

Future approved treatments are expected to be added to covered therapies, the NHF noted. The secretary of the U.S. Health and Human Services department has the authority to expand the list of treatments that may be billed for separately, and the foundation works to recommend additional treatments as well.

As more information becomes available, the NHF intends to continuously update its fact sheet.

People with questions or needing help with getting an individual into an SNF can write to Marla Feinstein at [email protected]