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Guidance to SNFs on CMS Spell of Illness Waiver

Last updated on 6/22/2020

Information posted June 22, 2020

On March 13, 2020, in response to the effects of the COVID-19 outbreak, the Centers for Medicare & Medicaid Services (CMS) provided a waiver to cover additional skilled nursing facility (SNF) care without requiring a break in the spell of illness for beneficiaries who recently exhausted their SNF benefits. This waiver only applies to beneficiaries who have been delayed or prevented by the current public health emergency from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances. A new spell of illness is not required, and those beneficiaries can receive up to an additional 100 days of SNF Part A coverage. The waiver is effective March 1, 2020, through the end of the emergency declaration.

SNF providers must add a note or comment of “COVID-19” in Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice, Admission when requesting a renewed SNF stay.

Note: These forms may be reviewed by HHSC at a later date.

If a provider previously submitted a 3619 for this waiver and has questions, contact the Provider Claims Services hotline at 512-438-2200, Option 1.

If there is a policy question, send your question to NF.Policy@hhsc.state.tx.us.

If a provider has questions on the waiver itself, contact OPOLE_IFM_DALDENGP@cms.hhs.gov.