![\"Understanding](\"https:\/\/s3.us-west-2.amazonaws.com\/img.prod.aplaceformom.com\/main\/uploads\/sa-blog\/2015\/11\/Understanding-How-Medicare-and-Medicaid-Treat-Holiday-Leaves-of-Absence--350x350.png\")
<\/h1>\n<\/h1>\nHere we are in November and it\u2019s almost holiday time! Thanksgiving, Chanukah, Christmas, New Years\u2026fun times abound! <\/span><\/p>\n During this time of year, we often gather with family and friends, and nursing home residents are no exception.<\/span><\/p>\n At Regency Nursing, our residents also wish to participate\u00a0in family gatherings, but often worry how this may impact their Medicare\/Medicaid benefits and coverage at the facility.<\/span><\/p>\n This is an excellent question and one which I shall address in this article.<\/span><\/p>\n The first thing to recognize is that a Medicare<\/em> leave of absence and a Medicaid<\/em> leave of absence are not<\/strong>\u00a0subject to the same rules and regulations.<\/span><\/p>\n Medicare<\/strong> is synonymous with short term rehab<\/em>, whereas Medicaid<\/strong> is associated with long term care<\/em>. <\/span><\/p>\n By definition,<\/strong><\/em> a Medicare covered patient is only in the facility for a short period of time and Medicare would like to see them participate in a robust therapy regimen during this period, since the assumption is that said patient requires this level of care – otherwise they wouldn\u2019t be in the facility to begin with.<\/span><\/p>\n Therefore, when a Medicare patient takes a prolonged leave of absence from the facility, Medicare begins to question the premise regarding the continued eligibility of the individual.<\/span><\/p>\n To this end, Medicare creates a distinction between a leave of absence where the patient goes out for the day and returns<\/em> before midnight, versus a patient who spends the night outside<\/em> of the facility.<\/span><\/p>\n In the Medicare manual, they write as follows: \u201can outside pass or short leave of 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 (Skilled Nursing Facility) for the receipt of required skilled care.\u201d<\/span><\/p>\n Therefore in Medicare\u2019s lexicon, if the patient leaves the facility but returns before midnight, the facility can still bill Medicare for this day, as a \u2018covered day of service,\u2019 whereas if the patient stays away from the facility past midnight and returns the next day, the day the resident leaves is considered a day of absence and the facility will therefore bill the resident privately for this day since Medicare will not cover.<\/span><\/p>\n One caveat is in chapter 6 of the Medicare manual, where they instruct the facility that they may not bill the beneficiary during a leave of absence, unless the facility shall inform the patient in advance that this will be a privately paid \u2018bed hold.\u2019<\/span><\/p>\nMedicare leave of absence<\/h2>\n
Medicaid leave of absence<\/h2>\n