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 Medi-Cal differ, both programs will permit, and reimburse the facility for, short leaves – depending on how long the leave is. This is particularly important during the holidays, when relatives want nursing home residents to join in the family festivities.
The Medicare Policy Manual, Chapter 1§ 22.214.171.124, 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, since the daily rate at a nursing home can be high.
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). This is a much more liberal leave policy than Medicare, but it is also subject to certain restrictions. The resident, family members and/or friends should ensure that provisions for leaves of absences are included in the resident’s care plan.