Nursing facility (NF) refers to long-term care facility certified by the state survey agency (SSA) to provide services to Medicaid recipients. NFs typically provide long-term care, though they can also provide rehabilitative care to Medicaid beneficiaries following hospital discharge. Individuals whose rehabilitative stay is expected to last less than 30 days need not undergo a PASRR Level II evaluation. This exception to the general rule is the so-called "hospital discharge exemption."
Skilled nursing facility (SNF) refers to a facility which provides rehabilitative care to Medicare beneficiaries. Like a NF, SNFs are certified by the SSA to provide such care.
Most facilities are certified both as NFs and as SNFs. A given facility can have both "NF beds" and "SNF beds", making them "dually certified." NF beds are occupied by Medicaid beneficiaries, while SNF beds are occupied by Medicare beneficiaries. Individuals can be "dual beneficiaries," eligible both for Medicare and for Medicaid. Such individuals can move from the SNF portion of a facility (which provides rehabilitative care) to the NF portion of a facility (in the event that long-term care is needed).
Individuals who are discharged from a hospital into a SNF bed in a dually certified facility must undergo a full PASRR. This is because the crucial fact, as noted at §483.102, is that the certification of the facility, and not the individual's form of insurance -- private pay, Medicare, or Medicaid – determines the need for PASRR. If a facility is certified as NF (i.e., certified by Medicaid), then PASRR applies to everyone seeking admission to that facility.
Additionally, before individuals can move from a SNF to a NF -- whether in the same facility or in a different facility -- a PASRR must be completed.