Residents of skilled nursing facilities can leave their facility to attend a family holiday celebration without losing their Medicare coverage! The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility,

an 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 for the receipt of required skilled care.[i]

A facility should not notify patients that leaving the facility will lead to loss of Medicare coverage. Such a notification is “not appropriate,” says the Manual.

If the resident returns to the facility by midnight, the facility can bill Medicare for the day’s stay.[ii] 

If the resident is gone overnight (i.e., past midnight) and returns to the facility the next day, the day the resident leaves is considered a leave of absence day.  While the facility cannot bill Medicare for leave of absence days, it also cannot bill the beneficiary for those days.[iii] 

The Center for Medicare Advocacy wishes everyone a safe, happy, healthy holiday season.