Nursing home and skilled nursing facility care

Kaiser Permanente does not cover residential-level or custodial-level nursing home care. Depending on the member benefit, Kaiser Permanente does cover intermittent therapy needs identified in the LTC/Custodial Care setting. The therapist in the nursing home will submit orders and therapy evaluations to Nursing Home Services in order to get authorization for this service.

Arranging for long-term care services
Once a member selects a nursing home for long term care, their primary care provider or personal physician will work with clinic social worker to request placement. Below is a list of most frequently required information. Please contact the nursing home directly to determine all paperwork required.

• Physician admission orders
• Specific diagnoses for all medications
• Current history and physical or emergency department evaluation
• Therapy evaluations and recent progress notes, if applicable

The personal physician or their representative must notify Nursing Home Services of custodial placement. Leave a voice message at 1-800-887-3873 with the following information:

• Member name
• Kaiser Permanente member ID
• Date of birth
• Name of nursing home
• Admission date

Kaiser Permanente Nursing Home Services coordinates skilled nursing facility (SNF) services.

Kaiser Permanente members may receive inpatient care in one of our in-network SNFs when that care is preauthorized by a Kaiser Permanente Care Management representative. We must review all SNF admissions to determine whether the member meets SNF criteria to issue an authorization or a notice of non-coverage. In order to meet Medicare Criteria, patients must have a daily nursing or therapy need.

Arranging for services
All SNF placements require prior authorization. If the member is in the hospital, discharge planners will arrange for SNF placement. If a member is in your office, request prior authorization online or contact Nursing Home Services toll-free at 1-800-887-3873.

In order to determine whether the member meets clinical criteria, has a SNF benefit, and which facility can meet their care needs, we will need the following information:

• Member name and Kaiser Permanente ID number
• Reason for referral
• Physician admission orders
• Specific diagnoses for all medications
• Current history and physical or emergency department evaluation
• Therapy evaluations and recent progress notes, if applicable
• Pre-admission screening resident review (PASRR)

Contracted providers
Contracted providers are expected to follow the standards of care outlined in the Skilled Nursing Facility Services guideline.