If a nursing home gives a Medicare or Medicaid recipient a hard time about leaving for a few days, the resident should contact his or her attorney.
There are a number of occasions that nursing home residents would like to enjoy with their families, but may fear losing their Medicare or Medicaid coverage if they leave the nursing home. Typically, Medicare recipients can leave for a day or two, and likely be billed to hold their beds. If you are a Medicaid recipient it is best to verify the procedure with your state.
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Only “skilled care” is offered under Medicare’s coverage of nursing home care. Skilled care is treatment provided by a doctor or nurse. Coverage can seize if a patient is no longer benefitting from this skilled care. With that said, the Medicare policy manual states that a brief leave of absence to attend a family occasion is not alone evidence that the resident no longer needs to be in the nursing home. In addition, the manual states that staff should not tell a resident that leaving the facility will result in a lapse of coverage.
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In the event 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 a resident wishes to leave for a few days, the best practice is to determine whether the nursing home can hold their bed. Nursing homes often charge residents a bed-hold fee in order to prevent the space from being taken.
A “therapeutic leave” is the term for when Medicaid recipients leave a nursing home to visit family. State laws regarding therapeutic leave vary immensely. Certain states will pay to hold a bed for up to 30 days a year, while others pay nothing at all for this type of leave. Before a resident leaves a facility, nursing homes are required to provide the resident with information about their bed-hold policy. Also, if a Medicaid recipient is absent for longer than the nursing home’s policy allows, federal law requires the nursing home to readmit the recipient to the first available room.
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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.
Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000
