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.

In addition to the commitment to Quality Improvement noted in the Kaiser Permanente service delivery standards section of this manual, contracted providers are expected to participate in Quality Improvement activities and provide Quality Reporting on a quarterly basis, utilizing quality metrics, targets and national benchmarking data, when available (“Quality Standards”).

Participation in Quality Reporting for Nursing Home Care

The Provider Quality Scorecard will be submitted to Kaiser Permanente, including its most recent CMS Nursing Home Compare overall rating score, as published and updated from time to time by CMS, no later than the 15th of month following each calendar quarter.

The Provider Quality Scorecard will include metrics, Quality Standards and targets that include but are not limited to those outlined below. No more than annually will the targets be reset in accordance with the contracted providers’ performance.

To assist you in meeting the performance goals, you may request quarterly information from Kaiser Permanente, which will provide the status of its current performance. In the event you experience a substantial increase in the acuity or complexity of Members referred by Kaiser Permanente, which may adversely impact your ability to meet the Targets and/or Quality Standards, you will notify Kaiser Permanenete, as soon as practicable.