Leaving the Nursing Home During a Medicare-Covered Stay
The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility for health care related reasons,
"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 (SNF) for the receipt of required skilled care." Chapter 8 section 30.7.3
The Manual elaborates: "Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences."
Medicare coverage for SNF care is based on 24-hour periods that run from midnight to midnight. So if a resident leaves the facility for a few hours and returns before midnight the facility can still bill Medicare for the day’s stay. If the resident is gone overnight and returns to the facility the next day, the day the resident leaves is considered a leave of absence day.
Clarifying, the Centers for Medicare & Medicaid Services (CMS) confirms that the facility can bill a beneficiary for bed-hold days during a temporary SNF absence. Not all facilities will charge this fee so it’s important to find out from the SNF administration in advance whether the bed can be kept open and what type of fee will be charged.
Residents can leave their SNFs for short periods, such as a day or two, to enjoy gatherings with their families and friends without losing Medicare coverage. SNFs are also allowed to bill residents to hold their beds under Medicare rules. Keep in mind that Medicare requires regular assessments to determine whether residents are receiving medically necessary and beneficial services that support skilled care and too many trips away from the facility could be construed as no longer needing skilled care leading to a discharge from skilled care.