Skilled Nursing Facilities' Financial Responsibility for Medicare Part D Enrollees' Drugs in Part A Stays

Medicare Part A prospective payments to skilled nursing facilities (SNFs) cover most services, including drugs and biologicals, furnished by a SNF for use in the facility for the care and treatment of enrollees. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to posthospital SNF care, because payment for the drugs is included in the prospective payment for a Part A SNF stay. A prior OIG audit found that up to $465.1 million in Part D total cost was improperly paid for drugs for which payment was available under the Part A SNF benefit. That audit also found that some of the drugs administered to Part D enrollees during their Part A SNF stays had been provided to the SNFs by the enrollees or their families, even though the SNFs were financially responsible for providing the drugs. For this audit, we will determine whether SNFs complied with Federal requirements for assuming financial responsibility for drugs for Part D enrollees in Part A SNF stays. For instances in which drugs used during enrollees' Part A SNF stays were provided by the enrollees or their families and paid for by Part D, we will determine why the SNFs obtained the drugs from the enrollees or their families.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
April 2025	CMS	Skilled Nursing Facilities' Financial Responsibility for Medicare Part D Enrollees' Drugs in Part A Stays	Office of Audit Services	OAS-25-09-057	2026