Advocacy Tip – Leaving the Nursing Home for Family Gatherings

Spring is often a time for gatherings with family and friends –
weddings, graduations, Mothers’ Day. 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 & Medicaid Services (CMS) confirms that the facility can bill
a beneficiary for bed-hold days during a SNF absence.

Read more on the Center for Medicare Advocacy website.

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