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PTA Blog Talk

Leave of Absence

Published April 9, 2014 10:35 PM by Jason Marketti

I have heard nursing staff, therapists and even social services tell patients they are not allowed to leave the facility or they'll lose their benefits for Medicare. Simply not true, and, in fact, Medicare makes it clear facilities should not tell patients that leaving the facility will lead to loss of coverage.

Patients can leave the facility for the purpose of attending a special religious service, eating a holiday meal, family occasions, going on a car ride, or a trial visit home. Patients can also leave for overnight stays without losing their Medicare coverage. The stipulation of an overnight stay is that the patient may be billed for a bed hold at the facility.

Perhaps people get the home health rules mixed up with the SNF rules. Home health rules limit outside activity when a patient's condition keeps him from leaving or it isn't recommended by an MD and leaving the home takes a considerable and taxing effort. These rules do not apply to the SNF. And by definition, a patient could leave the facility every day for a "short leave of absence." The "holiday meal" is awfully vague too when a patient requests to leave for Arbor Day, Valentine's Day, St. Patrick's Day etc. Technically the facility has to allow the patient to leave because of the way Medicare has worded it. And who am I to tell patients they shouldn't celebrate those days with a meal when I have the therapy room decorated for almost every "holiday" on the calendar.

I wasn't able to clarify what exactly a "family occasion" is according to Medicare either. Birthdays, funerals, christenings, third-grade graduations? The rules are not clear. However, if a patient's condition is improving enough to go out of the facility every day, I would assume a push for discharge is in the works. Essentially it would be up to the therapy department (the PT, OT, ST) to decide whether skilled care is still necessary for the patient's condition. And depending on how adamant a facility is about discharging patients who like to enjoy their Medicare benefits for 100 days, this may cause some problems.

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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