| Tue, Dec 20, 2016 @ 09:00 AM

Medicare Allows Nursing Home Residents Time Away with Family

Posted by Medicare Made Clear

nursing-home-residents-time-w-familyWith the holidays in full swing, many nursing home residents would like to be at home with their families but fear losing Medicare coverage if they leave for even a short amount of time.

According to MedicareAdvocacy.org, even though many Medicare beneficiaries are unable to leave their skilled nursing facility, the Medicare Benefit Policy Manual states1,

“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.”

That means a Medicare beneficiary living in a skilled nursing facility is allowed a leave of absence from the facility for a day or two without losing Medicare coverage.

  • The facility is allowed to bill Medicare for the day’s stay if the resident returns to the facility no later than midnight of the same day the leave began.
  • The facility is not allowed to bill Medicare for the day’s stay if the resident spends the entire night away from the facility or returns to the facility after midnight or the next day. When this happens, the facility is allowed to bill the resident a fee called a “bed hold” to hold their same bed in their same room and to maintain their personal belongings until the resident returns if the facility informs the resident the amount of the charge in advance of the leave and if the resident agrees to make the bed-hold payments.

Enjoy the holidays with your loved ones. Be sure to give the nursing facility staff a few days’ notice so they have time to prepare the resident’s medicines, supplies and a list of instructions.

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

Resources:

Medicare Made Clear: A resource for Medicare guides and information

Home for the Holidays: Complete with Medicare Benefit Policy Manual references MedicareAdvocacy.org

What Are My Rights & Protections in a Nursing Home?: Medicare.gov

1 Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay: Medicare Advocacy Organization (MedicareAdvocacy.org), May 15, 2014

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