My Sub A Cute / Rehab Patient on
Medicare Wants to Go On a Trip?

Recently, I was asked the rules regarding patients leaving the facility
for a few hours to either attend a scheduled activity program or to go out to Easter
dinner with family. After calling many other consultants, rehab directors and MDS
coordinators, I was lucky to talk with the Maria Young, MDS Coordinator at Bergen
Regional Medical Center and she was able to pass on the following information
regarding trips. Everyone should print this information out and place in your policy
manual. As there really is a great deal of misinformation regarding this topic. We also
recommend that you always check with your state regulations as some times
regulations may be different from state to state.   For all facility activity trips, always
make sure the physician has signed off on the orders that the patient can participate in
activities and attend scheduled trips.  Any resident who is a rehab or sub a cute patient
or short term stay, it is recommended that the activity staff document in the chart about
the trip, response and concerns.  Always coordinate facility trips with the rehab
department because the primary reason a short term stay patient is in your facility is for
therapy.  

If at all possible, schedule the trips with the rehab department and ask that a therapist
attend the trip.  Some facilities offer re-integration trips which is a different focus that a
leisure trip.  
________________________________________

Please refer to Medicare A manual, under 30.7.3 “Practical Matters”.
HOME FOR THE HOLIDAYS - YOU CAN LEAVE THE NURSING HOME!  (November
2008 Update)

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.

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.

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 is today unclear whether the facility
can bill the beneficiary for those days.

As the Center for Medicare Advocacy has reported in prior years, Chapter 6 of the
Medicare Claims Processing Manual says that the facility cannot bill a beneficiary
during a leave of absence.  However, a new provision in Chapter 1 of the Medicare
Claims Processing Manual, issued May 30, 2008, authorizes skilled nursing facilities to
bill a beneficiary for bed-hold during a temporary "SNF Absence" if the SNF informs the
resident in advance of the option to make bed-hold payments and of the amount of the
charge and if the resident "affirmatively elect[s]" to make bed-hold payments prior to
being charged.   Whether these apparently contradictory provisions in the Medicare
Claims Processing Manual can be reconciled remains to be seen.
Pathways to the Past
by Sandra Stimson ADC, CALA, CDP
Executive Director,
Alternative Solutions in Long Term Care
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