A week prior to Thanksgiving, I met with a client whose husband was in a local nursing home for a rehabilitation stay following a fall that resulted in hospitalization. The wife 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 do so for health reasons. The nursing home originally informed our client that her husband leaving the nursing home during a Medicare-covered stay would result in a loss of coverage 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 country. Nursing home residents often want to participate in family gatherings but may worry they will lose coverage by leaving the nursing home during a Medicare-covered stay. Nursing home residents and their families should not worry.
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 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 nursing home during a Medicare-covered stay 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, 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.
And in case you were wondering, our client, with the help of our office, was able to go home on Thanksgiving Day to spend it with family, and returned to the SNF under a Medicare-covered stay.
We wish our clients, their families, and our friends a joyous and fulfilling holiday season!
