Skilled Nursing and the 3-Day Rule

A major health event is often an unfamiliar experience and navigating skilled nursing care can be one of the more challenging aspects.

Skilled nursing care provides essential support for recovery before returning home, normally in the treatment of physical, speech, or occupational therapy, but there are qualifications you must meet:

A Qualifying Medical Condition
Your need for skilled nursing must relate to a condition treated during your hospital stay, even if it wasn’t the primary reason for your admission.

3-Day Hospital Stay
Medicare requires a minimum three-day inpatient hospital stay before skilled nursing care approval. This includes the day you’re admitted but excludes the day of discharge. An easier method is to count 3 midnights spent as an admitted inpatient to ensure eligibility.
• Important note: Time spent under “observation” doesn’t count as an inpatient stay, unless the observation was for 24 hours or more. For example, if you’re held for observation overnight for less than 24 hours, your three-day count starts the day you’re officially admitted. Always confirm your admission status with hospital staff.

Exceptions to the 3-Day Rule
You may not need a 3-day minimum inpatient hospital stay if your doctor participates in an Accountable Care Organization or another type of Medicare initiative approved for a “Skilled Nursing Facility 3-Day Rule Waiver.” Always ask your doctor or hospital staff if Medicare will cover your SNF stay. Medicare Advantage Plans may also waive the 3-day minimum. Contact your plan for more information.

October 2024 Ruling
Starting in October 2024, Medicare will cover skilled nursing care for patients who spend at least 24 hours in observation status, as long as they meet specific medical criteria. This policy change marks a significant expansion, providing greater access to critical post-hospital care in a nursing home setting for those who need it most.

Potential for Improvement
Medicare requires that skilled nursing services are necessary for recovery and that there’s potential for improvement through rehabilitation.

Doctor’s Certification
A doctor must certify (and periodically re-certify) your need for skilled nursing care.

While alternate circumstances may exist, the primary requirements for Medicare-covered skilled nursing are:

• A 3-day hospital stay
• A qualifying condition from your hospital stay
• Evidence of potential improvement
• Doctor certification

If you disagree with a hospital discharge that impacts your eligibility, you can appeal. Learn more here about your appeal rights.