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The CMS Internet only manual at www.cms.hhs.gov/manuals/102_policy/bp102c08.pdf includes the following quote under Example:
The “practical matter” criterion should never be interpreted so strictly that it results in the automatic denial of coverage for patients who have been meeting all of the SNF level of care requirements, but who have occasion to be away from the SNF for a brief period of time. While most beneficiaries requiring a SNF level of care find that they are unable to leave the facility, the fact that a patient is granted 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. Where frequent or prolonged periods away from the SNF become possible, the intermediary may question whether the patient’s care can, as a practical matter, only be furnished on an inpatient basis in a SNF. Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences. (See the Medicare Benefit Policy Manual, Chapter 3, “Duration of Covered Inpatient Services,” �20.1.2, for counting inpatient days during a leave of absence.)
Roberta S Cline, MS, LNHAA, RAC-C Consulstant Pathway Health Services 2025 Fourth Street White Bear Lake, MN 55110 C: 651-260-6940 e-mail: [EMAIL PROTECTED]
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Could someone please, once again, tell me where I can find information that residents on Medicare A may leave the facility to visit family, go to church, etc. Also, is there any regulation that says we must have a doctor's order for a resident to leave the facility for a few hours at a time for visit's, church, etc. Thanks so much Jen |
