Dear Advocate:

My mother is in a nursing home and we want her to be able to join in the family festivities this holiday season. We would like to be able to take her out of the nursing home for the day, maybe even have her stay the night, but we are worried that she will lose her Medicare or Medi-Cal coverage. Will there be any repercussions if we bring her home for the day or night?

Sincerely,
Dreaming of a Christmas with Mom

Dear Dreamer,

You don’t have to dream anymore. Nursing home residents can leave for short periods to enjoy the holidays or for visits with friends and relatives without losing Medi-Cal or Medicare coverage. Chapter1§ 30.1.1.1 of The Medicare Policy Manual states that residents who leave the facility for an “outside pass or short leave” can do so without losing their coverage. If they return by midnight, the facility can bill Medicare for the day. If the resident is gone overnight (past midnight) and returns the next day, this is considered a leave of absence and the facility can bill the beneficiary to hold the bed during an absence. In these cases, you should ask the facility what the cost will be.

Under Medi-Cal rules, a leave of absence (LOA) of up to 18 days per calendar year can be granted to a Medi-Cal resident of a nursing home in accordance with the resident’s plan of care, and the facility will continue to be reimbursed for care. Up to 12 additional days of leave per year can also be granted under certain conditions. (see 22 CCR §51335)