What is the Three-Day Skilled Nursing Facility Rule Waiver?

A. This waiver allows for a Medicare beneficiary, aligned with a Next Generation ACO (that is participating in the waiver), admission to approved SNFs from their home, a physician’s office, or an observation status in the emergency room; or when they have been in the hospital for fewer than three days.


  1. The beneficiary cannot reside in a nursing home or skilled nursing facility for long-term care when admitted to a SNF.
  2. The beneficiary meets all other CMS criteria for SNF admission to include: 
    1. Be medically stable.
    2. Have confirmed diagnoses (does not have conditions requiring further testing for more appropriate diagnosis).
    3. Not requiring inpatient hospital evaluation or treatment.
    4. Have an identified skilled nursing or rehabilitation need that cannot be provided on an outpatient basis or through home health services.

Skilled nursing facilities must have an overall rating of three or more stars under the CMS 5 Star Nursing Home Quality Rating System to be eligible.