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Inpatient Skilled Nursing Facility Care for Federal Employee Standard Option Members

Blue Cross and Blue Shield of North Carolina’s (Blue Cross NC) Federal Employee Standard Option members without Medicare Part A can receive inpatient care at a skilled nursing facility:

  • For a maximum of 30 days, annually
  • When the member is expected to benefit from short-term, skilled nursing facility services
  • With a goal of returning home

For this to occur, the following criteria must be met:

  • The member must be enrolled in Case Management prior to admission to the skilled nursing facility (signed consent required)
  • The member must actively participate in Case Management, both prior to and during their admission to the skilled nursing facility
  • Pre-certification must be obtained prior to admission, including overseas care
  • Blue Cross NC must approve the preliminary treatment plan prior to admission, and the plan must include proposed therapies, and document the need for inpatient care
  • The member must participate in all treatment and care planning activities, including discharge planning/transition to home

Benefits are not available for inpatient skilled nursing facility care solely for the management of tube feedings, home level dialysis treatment, interim transition to long-term care placement, or for any other non-covered services.