Medicare

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.

If you have other questions, feel free to send them to us at websupport@ezelderlaw.com.

Published by
David McGuffey

Recent Posts

Social Security Disability versus Veteran’s Disability

The word disability doesn't have the same meaning in all contexts. If you have a…

21 hours ago

Social Security Announces 2.5 Percent Benefit Increase for 2025

On October 10, 2024, the Social Security Administration announced that Americans will increase a 2.5…

4 weeks ago

Getting Organized

Many people think that estate planning is just having documents prepared. They have a lawyer…

4 weeks ago

Beneficiary who accepted inheritance under Will could not bring action for tortious interference

In Chambers v. Edwards, 365 Ga. App. 482 (2022), William Chambers sued his sister, Kathy…

1 month ago

Medicaid’s payment of medical bills does not bar recovery from negligent party

When an injured party sues someone who negligently injured him or her, one form of…

1 month ago

Market Observations from David Hultstrom

From time to time we re-post David Hultstrom's Financial Foundations. Mr. Hultstrom, who is a…

1 month ago