Can a nursing home resident leave for a family meal while covered under Medicare days?

Sometimes nursing home residents want to leave the nursing home to visit family or just get some fresh are. So can they do that while Medicare is paying for skilled therapy. This question was address in a November, 2019, blog post by the Center for Medicare Advocacy. The article cites footnote of the Medicare Benefit Policy Manual, Chapter 8, section 30.7.3 (at pdf page 43). The example includes the following statement: “While most beneficiaries requiring a SNF level of care find that they are unable to leave the facility, the fact that a patient is granted 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 SNF for the receipt of required skilled care.”

CMA’s blog post states: “If the resident begins a leave of absence and returns to the facility by midnight of the same day, 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.” Facilities can bill the resident for bed holds while the resident is gone.

So the answer is, yes, short excursions stays are permitted. Longer ones might call into question whether the resident needs to be in a skilled nursing facmilty.

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