Nursing home residents and their family members often worry about losing their rooms or their Medicare or Medi-Cal status if they leave the facility for brief periods of time. While the rules for Medicare and MediCal differ, both programs will permit, and reimburse the facility for short leaves – depending on the length of the leave. With the COVID-19 public health emergency, there are important recommendations from the Department of Public Health to remember when leaving the facility to visit family members and procedures that will be implemented upon return.
On December 8, 2021, the California Department of Public Health released guidance to nursing facilities advising them that residents may leave their facilities to celebrate with their families and friends. The letter directs facilities to educate residents about COVID-19 precautions, and infection prevention and control measures. It states that “fully vaccinated residents who leave for any duration and return to the facility do not routinely need to quarantine and be tested upon return to the facility.” Facilities are instructed to screen residents returning from outside holiday celebrations for signs and symptoms of COVID-19. Residents who leave their facility may be subject to testing or quarantine requirements if they are unvaccinated or if they are exposed to someone infected with COVID-19 while they are outside their facility.
Residents whose skilled nursing facility care is paid for by Medicare can leave the facility for short visits, subject to Medicare rules. The Medicare Policy Manual states that residents who leave the facility for 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 trial visit home” can do so without losing their coverage. By taking a temporary leave of absence for these purposes, Medicare recognizes this does not necessarily indicate the resident does not meet the skilled nursing facility level of care (Chapter 8 §30.7.3). 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. Chapter1§ 18.104.22.168, outlines how Medicare beneficiaries may take a brief leave of absence by making out of pocket payments to the facility. If planning to leave temporarily, you should ask the facility what the cost will be, since the daily rate of room and board at a nursing home can be high.
Residents whose nursing home care is paid by Medi-Cal have a much more liberal leave policy, but it is also subject to certain restrictions. Under Medi-Cal rules, a leave of absence 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 in increments of two days may also be granted under certain conditions. See 22 CCR §51335 as specified conditions are outlined. The resident, family members and/or friends should ensure that provisions for leaves of absences are included in the resident’s care plan.