In re A.S.

SSA Office of Hearings & Apps. July 14, 1995). ; Clearinghouse Number: 51428

Description

Claimant Entitled to Medicare Coverage for 250 Days of Hospital Stay

Abstract

The administrative law judge (ALJ) has held that claimant is entitled to Medicare coverage for a hospital stay of over 150 days. Claimant, a 95-year-old man, was admitted to the hospital for advanced dementia, diabetes mellitus, anemia, and a history of gastrointestinal bleeding. Although he was referred for a skilled nursing placement within five days of his hospitalization, no beds were available and he was not transferred to a skilled nursing facility (SNF) until after 295 days in the hospital. Claimant argued that he had required and received an SNF level of care after his first 150 days of hospital confinement; that, had an SNF been available at the end of the 150 days, he would have been transferred and received 100 days of Medicare coverage at the SNF; and that he should not be deprived of the Medicare SNF benefit simply because, through no fault of his own, no SNF bed was available to him. The ALJ held that claimant was entitled to Medicare coverage through 250 days of his hospital stay, including 150 days of hospital coverage and 100 days of SNF coverage.

Additional Information

Attorney Information
Claimant represented by Edward Dale, Elder Law & Legal Assistance to Medicare Patients, 872 Main St., P.O. Box 258, Willimantic, CT 06226-0258; (860) 456-1761.
Docket Date
1970-01-01 06:00:00+00:00