Can and should nursing home residents leave the facility for the holiday? If a resident decides to leave the facility for the holiday, CMS recommends certain actions when the resident returns. Consider this scenario:
A client was in a local nursing home for a rehabilitation stay following a fall resulting in hospitalization. His spouse communicated that her husband wanted to come home for the day to spend Thanksgiving Day with his family, and would be devastated if he was unable to due so for health reasons. The nursing home originally informed our client that her husband would lose his Medicare coverage for the rehabilitation stay if he went home for the day because it would be evidence that he no longer was in need of skilled nursing care.
The above scenario is likely to be played out this month at nursing homes throughout the US. Nursing home residents often want to participate in family gatherings but may worry they will lose Medicare coverage if they leave the nursing home to do so. Nursing home residents and their families should not worry.
Please note on November 18, the Centers for Medicare & Medicaid Services (CMS) issued an Alert for nursing facilities, residents, and families recommending that residents not leave their facility during the public health emergency. This CMA Alert discusses the new CMS recommendations and then longstanding provisions in the Medicare Manuals that govern Medicare coverage.
CMS begins its Alert by recognizing that residents may want to spend the holidays with family and friends. However, while CMS “supports . . . a resident’s right to leave the nursing home,” it encourages everyone to take “extra precautions to help reduce the spread of COVID-19, which can pose an elevated danger to the health of nursing home residents.” Accordingly, “CMS recommends against residents leaving the nursing home during this PHE [public health emergency].” CMS encourages facilities to “find innovative ways of celebrating the holidays without having parties or gatherings that could increase the risk of COVID-19 transmission (e.g., virtual parties or visits, provide seasonal music, movies, decorations, etc.).”
If a resident chooses to leave the facility for the holiday, however, CMS suggests various actions, such as wearing facemasks at all times, avoiding large gatherings, conducting gatherings outdoors, and checking local conditions and state requirements. CMS also recommends that nursing home staff follow the same precautions that it identifies for residents.
If a resident decides to leave the facility for the holiday, CMS recommends certain actions when the resident returns. These actions include screening and increasing monitoring for signs and symptoms of COVID, testing the resident with signs or symptoms, and placing the resident on transmission-based precautions.
Nursing home residents may leave their facility for family events without losing their Medicare coverage. However, depending on the length of their absence, Medicare beneficiaries may be charged a “bed hold” fee by the skilled nursing facility (SNF). It is true that Medicare coverage ends when a patient no longer is in need of skilled care. However, section 30.7.3 of Chapter 8 of the Medicare Benefit Policy Manual states “absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a care 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.”
Furthermore, the regulations state it is “not appropriate’ for an SNF to tell a patient that leaving the facility will lead to a loss of Medicare coverage.
What about overnight absences?
If the resident is gone overnight and returns to the facility the next day, Medicare will not pay the SNF for days when the patient is absent. The SNF can charge the resident a “bed hold” fee for a temporary absence if the SNF informs the resident in advance of the option, the amount of the charge, and the resident affirmatively elects the bed hold charge.
In summary, other than the current health care emergency, there is no reason why residents cannot be taken out of the SNF for short periods, such as a day or two, to enjoy holiday gatherings without losing Medicare coverage as long as they are well enough and have the appropriate support they need while away.
We wish our clients, their families and our friends a safe and joyous and fulfilling holiday season.
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