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My father (78) had a stroke about 4.5 weeks ago. After a hospital stay, he was moved to an inpatient rehabilitation hospital. The rehab requested 28 days but Medicare only approved 23 days.
The facility is amazing and he is making great progress but his starting point was just so severe (full right side paralysis, loss of language and fine motor skills) that we would love for him to stay as long as he can to regain function. There aren't any good SNF in the area for him to step down to.
Any tips for an appeal? From what I understand from the case manager, this is an acute care hospital so there needs to be a reason for him to be here due to medical necessity. I don't think that the improvement standard (Jimmo) is reason enough to keep him here. Any help is appreciated.

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So the good news is that we won the appeal. The bad news is that it is only for an additional 4 days - determined by the hospital. While my dad is making progress, that 4 days will include a weekend where he gets less therapy.

From talking with the rehab hospital case manager, they do not get paid any additional for those 4 days. Is this correct?

She also mentioned that she would setup some referrals to SNFs when we've been clear that he would be discharged to home. So i felt some pressure to not appeal again because of this. I think it was kind of a "well if you can't care for him after discharge, we'll arrange a SNF for you"

Does all of this make sense?
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AlvaDeer Nov 22, 2024
It does. I do think that this comes down to your decision to take him home and their feelings overall that placement would be better. Now this all depends really on how well able you are going to be to handle him at home. I worry that with all this trying for a few more days you are missing the forest for the trees.
There may not be a lot more improvement; you likely can see where this is going?
And if you do not think that you can care for him in home then a whole lot of time here that could have/should have been used for in facility care is being wasted really.
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Hi Chuck. You wrote us about this on November 8.
Were any of our answers in any way helpful to you?
What steps have you taken and are their social services being cooperative with your appeal.
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