Floor to SNF for in-network skilled nursing facilities

Effective June 1, 2023, Anthem Blue Cross and Blue Shield (Anthem) now allows a seven-day initial length of stay upon notification of an admission to an in-network skilled nursing facility (SNF) for Ohio Medicaid Managed Care members. Facility and physician must be in-network for the member.

Anthem requires notification of the SNF admission, which includes sending demographics and verification of benefits via the usual channel. Anthem will approve an initial seven-day length of stay without the need to provide clinical information.

Referring provider/facility or SNF is required to submit the SNF/Rehab Worksheet, PASRR (Preadmission Screening and Resident Review) form, and clinical information within three business days after the date of admission to aid in our members’ care coordination, discharge planning, and member management. Documentation listed is required before final determination is made by Anthem.

Concurrent review will be required starting on day eight of the SNF stay.

Anthem will conduct random audits and monitor trends to evaluate the effectiveness of this initiative.

Note: This process does not apply to admissions to out-of-network SNF facilities.

Refer to the frequently asked questions (FAQ) below for more information.

Frequently asked questions

As a SNF provider, do I need to send information and notification to Anthem as I would normally do for a prior authorization?

Yes, notification is still required. However, you can notify Anthem of the admission and move the member without having to send in clinical or wait for an approval. It will be important to verify member benefits and submit a PASRR form.

When do I need to submit clinical information?

For the initial SNF admission, submit the clinical information no later than eight business days after the admission, and for continued stay, prior to the last covered day.

Does this apply to SNF, inpatient (IP) rehab, and long-term acute care (LTAC) admissions?

This process is only applicable to the initial SNF admission. Follow standard prior authorization process for IP rehab and LTAC.

For the SNF initial authorization of seven days, will Anthem assign a level of care?

Anthem utilization management will assign level of care once the PASRR form and clinical information is received from the SNF.

What if a member needs to be admitted for wound care and intravenous (IV) antibiotics?

If a SNF has any concerns about the criteria for admission, they may still do the full prior authorization process.

If the physician and/or facility are out-of-network for the member, does this process apply?

No, the facility and physician both need to be in-network. All out-of-network facilities and providers must follow the full prior authorization process.

What disqualifies the member from the floor to SNF? 

A member must go through the standard precertification process when any of the following apply:

• Transfer to a SNF from an acute rehab facility
• Transfer to a SNF from a long-term acute care hospital (LTACH) facility
• Transfer to a SNF from a psychiatric/geropsychiatric hospital unit
• Member whose prior level of function (PLOF) is non-ambulatory
• Member has been admitted to a hospital from a SNF or acute rehabilitation facility
• Member was denied an LTACH admission
• Member was denied a standard SNF precertification request

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