Fall and winter are often a time for gatherings with family and friends – Thanksgiving, Christmas and New Year’s. Nursing home residents often want to participate in these gatherings but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. This is not true.
The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a skilled nursing facility for the receipt of required skilled care. A facility should NOT notify patients that leaving the facility will lead to loss of Medicare coverage. The Medicare Benefit Policy Manual says that such a notice is “not appropriate.”
If the resident begins a leave of absence and returns to the facility by midnight, the facility can bill Medicare for the day’s stay. If the resident is gone overnight (i.e., past midnight) and returns to the facility the next day, the day the resident leaves is considered a leave of absence day. Clarifying what seemed to be conflicting provisions in the Manuals, the Centers for Medicare and Medicaid Services (CMS) confirms that the facility can bill a beneficiary for bed-hold days during a SNF absence.
Ms. MacDonald’s practice is limited to Estate Planning, Probate, Elder Law and Trust Administration. Ms. MacDonald maintains her practice in the Santa Clarita Valley at 25115 Avenue Stanford, Suite B-124 in Valencia, California. She can be reached at 661-294-6464.