Old People's Clubs and $$ Flashcards
What levels are care are offered at senior living facilities
Independent Living
Assisted Living
Skilled Nursing Care
Memory Care Facility
What is required for Medicare A to cover rehab?
3 night inpt hospital stay required w/in 30 days admission into Skilled Nursing Facility for short term rehab
how many days will medicare A cover rehab 100%
1-20 days
How much will you pay with medicare A if you stay in a rehab facility for 21-100 days?
$157.50/day
**this may be covered by other insurance the pt has
With Medicare A coverage Resident must participate w/ daily ___ in order for Medicare A to cover stay. Weekly goals are set each week→ once resident has met all goals possible, Medicare will give a ___ day discharge notice
PT/OT
5
Medicare Part B covers ____ rehab services including home health PT/OT services
outpatient
With Medicare B a Yearly cap of $_____ (including deductible and coinsurance amounts) are offered for outpatient rehabilitation services
$1900
What will medicare not pay for once >$1900 has been reached?
PT
speech-language pathology
occupational therapy
What coverage can a pt use if they have not has a 3 night inpt stay if they require PT/OT/Speech
What will the pt be responsible for paying?
Medicare B ($1900 cap applies)
room and board (~$270/night)
____ Do not require 3 night inpatient hospital stay to cover skilled nursing facility (SNF)
Medicare replacement plans
What do Medicare replacement plans require ___ and ___ submitted for approval prior to skilled nursing facility admission.
what are examples?
prior authorization and clinicals
PT/OT eval
H&P
Meds
FL2
Authorization for Medicare replacement plans is granted for ___ days at a time→ Clinicals must be submitted every ___ days by facility in order to replacement plans to pay for SNF
**same answer for both!
7
What procedures are included in the Medicare Bundle?
joint replacements
Trauma
how many days are included in the medicare bundle plan?
7 days to send them home
Is a 3-day inpt stay required to qualify for the Medicare bundle?
no
what is needed when applying for Medicaid
ID POA Money (bring it all..bonds, safe deposits, trust funds, 401 K, cars, property--> 5 year Financial Hx) Insurance policies Prepaid burial contract VA claim #
With medicaid…
- Get to keep $___/mo for personal use
- May have up to $____ total for personal use (more could affect Medicaid eligibility)
- ___ coverage need to be changed w/ Medicaid
Residents w/ Medicaid qualify for ___ plans w/ no monthly fee (can call or go online to sign up)
$30
$2,000
Rx
Part D
How does NC define assisted living?
- group housing for 2+ unrelated adults
- 1 meal/day + housekeeping
- personal care services
What are 3 examples of Types of Assisted Living
- Adult Care homes
- Group homes for developmentally disabled adults
- Multiunit Assisted Housing w/ Services
