Skilled Nursing Facilities Certification Requirements

Published 12/14/2022

The Medicare Skilled Nursing Facilites (SNF) benefit pays for certain skilled services provided in various skilled nursing settings, including swing-bed hospitals, nursing homes and other freestanding facilities; only if the certification and recertification for services meet certain content criteria. There are no specific procedures or required forms for certification and recertification statements.

Provider may use any method that allows for verification. The certification and recertification statements may be entered on forms, notes, or records that the appropriate individual signs, or on a special separate form. If the required criteria are contained in other provider records, such as physicians’ progress notes, it need not be repeated. A statement to indicate where the information is to be found will suffice. For example, if appropriate, the provider could sign and date a statement that indicates all the required information is included in the medical record and continued post hospital extended care services are medically necessary.

Certification Statement Required Criteria
The certification must clearly contain the following information:

  • The individual needs skilled nursing care (furnished directly by or requiring the supervision of skilled nursing personnel) or other skilled rehabilitation services
  • Services are required daily
  • Services can only be provided in a SNF or swing-bed hospital on an inpatient basis
  • Services are for an ongoing condition for which the individual received inpatient care in a hospital, or for a new condition that arose while the individual was receiving care in the SNF or swing-bed hospital for a condition for which he or she received inpatient care in a participating or qualified hospital
  • A dated signature of the certifying physician or NPP

Recertification Statement Required Criteria
The recertification statement(s) must contain the following information:

  • The reasons for the continued need for post-hospital SNF care
  • The estimated time the individual will need to remain in the SNF
  • Plans for home care if any
  • If the reason for continued need for services is a condition that arose after admission to the SNF (and while the individual was still under treatment for the condition for which the individual received inpatient care in a hospital) this must be indicated
  • A dated signature of the recertifying physician or NPP

Timing of Certifications and Recertifications

  • The certification must be obtained at the time of admission or as soon thereafter as is reasonable and practicable
  • The first recertification is required no later than the 14th day of post-hospital SNF care
  • Subsequent recertifications are required at least every 30 days after the first recertification
  • SNFs are expected to obtain timely certification and recertification statements. However, delayed certifications and recertifications will be honored where, for example, there has been an isolated oversight or lapse. In addition to complying with the content requirements, delayed certifications and re-certifications must include an explanation for the delay and any medical or other evidence which the SNF considers relevant for purposes of explaining the delay.

Educational References and Resources


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