Medicare Part A will cover skilled nursing care if: Skilled nursing care / skilled therapy are needed, per Medicare standards, to help improve a condition or maintain one’s current condition and prevent or delay it from getting worse (i.e. plateauing is not, itself, a good reason for discharge); and you have a qualifying hospital stay (inpatient for three consecutive days or more) shortly before entering a skilled nursing facility.

The Long-Term Care Ombudsman Program investigates deviations of Florida nursing home resident’s rights in, including complaints of nursing homes prematurely discharging / transferring except for the following reasons:

  • The resident's welfare cannot be met at the facility.
  • The resident's health has improved sufficiently so the resident no longer needs the services provided by the facility.
  • The health or safety of individuals is endangered.
  • The resident has failed, after reasonable and appropriate notice, to pay or have paid under Medicare or Medicaid for residence at the facility.
  • The facility closes.

The long term care ombudsman program is a division of the Florida Department of Elder Affairs and is separated into 13 Florida districts that investigate and resolve complaints made by (or on behalf of) those in assisted living facilities (ALF) and residents of nursing homes (skilled nursing facilities).

A nursing home must give residents 30 days written notice prior to discharge or transfer. A resident who thinks their rights have been violated (to avoid premature discharge or a number of other rights, such as: private communication, visitation rights, refuse treatment, be informed of medical conditions/proposed treatment, be treated courteously, fairly and with dignity, and more) must request a hearing in writing within 90 days by sending the form given to them by the facility to:

Office of Appeals Hearings | Telephone: 850-488-1429

1317 Winewood Boulevard, Building 5, Room 203,

 Tallahassee, FL 32399-0700.

Requesting a hearing within 10 days (rather than 30) stops the removal of the resident until the hearing process is completed. A nursing home resident may request assistance from the Long-Term Care Ombudsman Program by calling 888-831-0404. 

Important Proof Needed to Appeal a Skilled Nursing Discharge

To appeal a premature or early discharge, you’ll need the physician who ordered your care to explain why your case continues to be medically reasonable and necessary.

About the Florida Long-Term Care Ombudsman Program

The long term care ombudsman program is a division of the Florida Department of Elder Affairs and is separated into 13 Florida districts that investigate and resolve complaints made by (or on behalf of) those in assisted living facilities (ALF) and residents of nursing homes (skilled nursing facilities).

Medicare Quality Improvement Organization

If you feel services are ending too soon at a Medicare-covered skilled nursing facility or Medicare covered outpatient rehab facility; at by a Medicare-covered home health agency, or at a Medicare-covered hospice facility, you can request a fast appeal at your Medicare Qualify Improvement Organization. Ask for a “fast appeal” no later than noon of the first day after you get a “Notice of Medicare Non-Coverage” from the facility. 

In Florida, the Medicare Quality Improvement Organization (QIO) is run by the KEPRO organization (who contracts with the Center for Medicare & Medicaid Services). Their contact information is: 

KEPRO Florida

5201 W. Kennedy Blvd, Suite 900

Tampa, FL 33609

844-834-7129