By Holly Carmona, Admissions Nurse at St. Ann’s Community 

It may sound odd, but if you’re admitted for inpatient rehab services at St. Ann’s Community, we start planning your discharge the day you arrive.

It’s true. Our goal, from the day you arrive from the hospital, is to return you to your previous level of activity, get you home safely as soon as possible, and help you avoid a return to the hospital.

That much is clear. But the question many people have is, “What’s the process for getting out of the hospital and into rehab, and what role does Medicare play?” Let’s walk through the steps.

Let’s say you’ve had hip surgery and the hospital is recommending a short-term rehab stay. The hospital’s clinical team will provide documentation of your need for rehab to your insurance provider. This includes documentation of your:

• Medical history
• Current medical event (the reason you were hospitalized)
• Your baseline level of function, and
• Your current level of function.

If your insurer determines that you qualify, they will authorize the stay (granting “prior authorization”) and you’re cleared to enter rehab.

For people age 65 and older who’ve received prior authorization, the cost of inpatient rehab services is covered by Medicare. Those services include physical therapy, occupational therapy, speech-language pathology, meals, nursing services, and prescription drugs.

Medicare is the national health insurance program administered by the Centers for Medicare & Medicaid Services. It covers people age 65 or older, as well as others who meet specific eligibility criteria.

Now the tricky part: Medicare coverage is not guaranteed for the duration of your rehab stay. Coverage is determined based on your daily participation in therapy and demonstrated progress toward your recovery goals.

Upon entering rehab, you will be visited by the members of your care team. At St. Ann’s, this includes professionals from our Medical, Therapy, Nursing, and Social Work departments as well as others depending on your needs. Working with you and your family, the team will develop a discharge plan with goals to reach to ensure you can return home safely.

This is important: To continue qualifying for Medicare coverage (“continued stay coverage” in technical terms), you must actively participate in therapy and demonstrate progress toward those goals. If for whatever reason you do not participate, coverage will end.

Also important, and something many people misunderstand: while Medicare does provide “continued stay coverage” for up to 100 days, it is not unlimited coverage for that whole period. You’ll have no co-pays or deductibles for up to your first 20 days in rehab, including all equipment, supplies, medications, and nursing care. However, from day 21 to day 100, you will be responsible for a daily co-pay per Medicare guidelines (in general, roughly $200 per day). Be sure you and your family don’t misinterpret this.

And don’t forget: where you go for rehab is up to you. If you pre-plan your stay at the rehab facility of your choice, you can be sure there will be a room waiting for you. You won’t have to worry about making last-minute decisions or settling for someplace that doesn’t meet your needs. Contact the Admissions Office of your preferred rehab center to pre-plan your stay.

Holly Carmona is an Admissions Nurse at St. Ann’s Community. She can be reached at [email protected]. For more information about rehab at St. Ann’s, click here.