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Characteristics of United States postacute care settings where rehabilitation may be provided

Characteristics of United States postacute care settings where rehabilitation may be provided
Rehabilitation site Medical coverage Therapy services Nursing Insurance
Inpatient rehabilitation (acute) Clinician available 24 hours/day, 7 days/week; active medical problem(s) requiring clinician supervision with visit 5 or more days/week PT, OT, and speech therapy available; patients must need 2 or more therapy services and must receive therapy 3 or more hours per day, 5 days per week. A multidisciplinary team conference is required within 4 days of admission and weekly thereafter. 24-hour care Medicare Part A: days 1 to 20: 100%; days 21 to 100: 80% plus copayment; >100 days: no coverage
Skilled nursing facility (subacute/transitional care unit) Clinician-supervised; clinician evaluation within 2 weeks of admission and every 30 days; clinician available in emergencies PT and OT available; typically 1 or more session per day 24-hour care Same as inpatient rehabilitation
Long-term acute care hospital Clinician available 24 hours/day; active/ongoing medical condition requiring clinician-level care (eg, ventilator-dependent) PT and OT available 24-hour care Same as inpatient rehabilitation
Home therapy/nursing Clinician referral and recertification every 60 days PT, OT, and speech therapy available Home health nursing Typically 1 to 3 visits per week by OT/PT for 1 to 3 weeks, 1 visit per week with RN, daily home health aid
Outpatient (hospital or freestanding clinic) Clinician referral and recertification every 30 days PT, OT, and speech therapy available N/A May be limitations in number of visits per year
Telehealth (may be utilized to/from any setting for care [eg, hospital, clinic, home], but without crossing state lines) Episodic and/or as needed; referral parameters not defined May be utilized for any noninvasive rehabilitation service (PT, OT, speech, rehabilitation medicine) N/A Variable, with coverage for use for rehabilitation in the Veterans Health Administration and Medicaid (most states), and with some programs in Medicare and private insurance
OT: occupational therapy; PT: physical therapy; RN: registered nurse.
Adapted from: Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, 7th ed, Pacala JT, Sullivan GM (Eds), American Geriatrics Society, New York, 2010.
Graphic 86677 Version 7.0

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