These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Prior authorization is required for skilled nursing facility admissions.
Some plans do have a Skilled Nursing Facility benefit with HealthPartners. Please see your plan documents for your own coverage information.
- Members who are applicants to a nursing facility must be screened through the pre-admission screening process prior to admission.
- The pre-admission screener will contact the health plan to coordinate the plan of care.
- HealthPartners is responsible for the services and medical needs while in the nursing facility.
- Care must be directed through a Primary Care physician.
- Nursing home daily rate is not covered by HealthPartners unless it is instead of an inpatient admission.
- For coverage of ancillary services, see applicable related coverage criteria (PT, OT, ST).
- Network affiliated facility:
- Care must be received in a network affiliated nursing home or hospital.
- Network affiliated facilities are those facilities at which a HealthPartners physician will make visits to patients.
- The physician must be of the same medical group at which the member is enrolled.
If a member chooses a non-HealthPartners affiliated facility, the member's care will be covered only if the member is transported to their primary clinic on a monthly basis for a doctor visit.
- Skilled rehabilitation care: Care must be skilled nursing care as defined by the generally accepted standard of Medicare guidelines, or care must be rehabilitative in nature.
Custodial care is not covered as defined by the certificate of coverage. Room and board costs for custodial care are covered by Department of Human Services.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_008996
- 07/01/1997 - Date of origin
- 02/01/2017 - Effective date