Long Term Care Skilled Nursing Facility (SNF) Bed Hold Requirements

The purpose of this bulletin is to communicate information related to bed hold limitations and guidelines.

The Welfare and Institution Code section 72520 for bed holds are limited to a maximum of seven days, after which the skilled nursing facilities (SNFs) cannot bill for a bed hold.

Please note that Long Term Care requires an authorization of bed holds for claims payment.

The SNF must hold a bed vacant when requested by the attending physician, unless the attending physician notifies the SNF that the member requires more than seven days of hospital care. A SNF cannot hold a bed after seven days and claims submitted for bed holds for more than seven days will be denied. Bed holds must be ordered by a licensed physician and must not be followed by a discharge within 24 hours.

It is important to note that federal regulations, 42 CFR Section 483.15(e)(1), also require certified SNFs to establish and follow written policy concerning residents returning to the facility after hospitalization or therapeutic leave. Such policy provides that:

• A resident, whose hospitalization or therapeutic leave exceeds the bed hold period under the state plan, returns to the facility to their previous room, if available, or immediately upon the first availability of a bed in a semi-private room if the resident:
  • Requires the services provided by the facility; and
  • Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services.
• If the facility determines that a resident, who was transferred with an expectation of returning to the facility, cannot return to the facility, the facility must comply with the requirements of 42 CFR Section 483.15(c) as they apply to discharges.

Customer care centers:

• Medi-Cal Managed Care (outside L.A. County): 800-407-4627
• Medi-Cal Managed Care (inside L.A. County): 888-285-7801