Reunions- graduations- birthdays- and holidays: Whatever the occasion- nursing home residents don’t want to miss out on family gatherings- but may be afraid that they will lose Medicare or Medicaid coverage if they leave the nursing home. In most cases- Medicare recipients can leave for a day or two- although the nursing home may bill them in order to hold their beds. Medicaid recipients will need to check with their state.
Medicare’s coverage of nursing home care is quite limited and it only covers “skilled care” – i.e.- treatment provided by a doctor or nurse. Coverage can stop if a patient is no longer benefitting from this skilled care. However- the Medicare policy manual states that a short leave of absence to attend a family occasion is not- by itself- evidence that the resident no longer needs to be in the nursing home. The manual also states that staff should not tell a resident that leaving the facility will cause coverage to lapse.
If a resident leaves and returns by midnight the same day- the nursing home can bill Medicare for the day. However- if the resident is gone overnight- Medicare will not compensate the nursing home for the time missed. If the resident wants to leave for a few days- he or she should check with the nursing home to make sure the bed can be held. The nursing home may charge the resident a bed-hold fee in order to keep the space available.
If a Medicaid recipient leaves a nursing home to visit family- it is called “therapeutic leave.” State laws regarding therapeutic leave vary widely. Some states will pay to hold a bed for as long as 30 days a year- while others pay nothing at all for such leave. Virginia DMAS does cover up to 18 therapeutic leave days within a 12 month period. During these 18 days- Medicaid will pay to hold the bed of the resident if the leave is within the resident’s plan of care and that is noted in the resident’s chart. Therapeutic leave includes visits to relatives or friends or admission to a rehabilitation center for up to 7 days for evaluation- but it does not include admission to an inpatient hospital.
Each nursing home is required to provide residents with information about their bed-hold policy before the resident leaves the facility. In addition- if a Medicaid recipient is absent longer than the nursing home’s policy allows- federal law requires the nursing home to readmit the recipient to the first available room. For a list of state bed-hold policies- click here.
If a nursing home gives a resident a hard time about leaving for a few days- the resident should contact his or her attorney.
For more information about Medicare’s nursing home coverage- click here.
For more information about Medicaid’s long-term care coverage- click here.