As we are now in the holiday season, one question many families are asking is, “can nursing home residents leave for the holidays?” If a resident decides to leave the nursing home for the holidays, CMS recommends certain actions when the resident returns. Consider the following 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 with his family and would be devastated if he was unable to do so for health reasons. The nursing home initially 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.
CMS Guidance during the Coronavirus Pandemic
Last year’s November guidance, which is still in effect but somewhat revised, confirms that “Facilities must permit residents to leave the facility as they choose.” With slightly revised language in 2022, CMS advises that the facility should remind the resident and any individual accompanying the resident “to follow all recommended infection prevention practices such as wearing a face covering or mask, especially for those at high risk for severe illness and when community transmission is high, performing hand hygiene and encouraging those around them to do the same.”
When residents return, they should be screened for signs or symptoms of COVID-19 and tested if they or a family member have been in close contact with someone who had COVID-19. If residents develop “signs or symptoms of COVID-19 after the outing,” the facility should follow CDC’s guidance for residents with symptoms.
The most significant change in CMS guidance in 2022 is the statement that reads, “In most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours . . . except in certain situations described in the CDC’s empiric transmission-based precautions guidance.” However, as in 2021, CMS recommends this year that “residents who leave for 24 hours or longer should generally be managed as a new admission.
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 is no longer in need of skilled care. However, the Medicare Benefit Policy Manual states, “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 the 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 and the amount of the charge, and the resident affirmatively elects the bed hold charge.
In summary, other than the current healthcare 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, joyous, and fulfilling holiday season.