This can still be found in the CMS Pub. 12, SNF Manual,�214.6,
"...Do not interpret the practical matter criterion so srictly 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 an SNF level of care find that they are
unable to leave the facility for even the briefest of time, 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 or family occasion, for going on a ride or for
a trial visit home, is not by itself evidence that the individual no longer needs to
be in a SNF to receive required skilled care. Very often special arrangements, not
feasible on a daily basis, have had to be made to allow for absence from the facility.
Where frequent or prolonged periods away from the SNF become possible, however, then
questions as to whether the patient's care can, as a practical matter, only be
furnished on an inpatient basis in an SNF may be raised. Base decisions in these cases
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 �242.3 for counting inpatient days during a leave of absence.)..."
It is prudent to have a physician order that the patient be allowed to leave for a
brief time out. You also want to have documentation that the patient/others
responsible for the patient, have been instructed and are adequately prepared in the
event of a change in condition. We live in a very litigious society. Is the LOA
clinically safe for the patient?
My dad was in a SNF receiving q4h IV antibiotic therapy via central line and a ride in
the car with my mom, for an hour, was so important to a 70 yr old man, totally alert,
who suddently found himself a patient in a nursing home with bacterial endocarditis!
The DON and I discussed it ahead of time and I was so relieved to find she was
familiar with 214.6 - those times away helped him keep his sanity!
Another SNF had a patient who wanted a LOA to go hunting in the woods for a few days!
That warranted, "It is likely this patient no longer requires inpatient SNF service!"
Lita D. Atkinson
-------
In a message dated 2/18/2004 5:12:22 PM Eastern Standard Time, [EMAIL PROTECTED]
writes:
>
> Subj: LOA
> Date: 2/18/2004 5:12:22 PM Eastern Standard Time
> From: "Jennifer Roberts" <[EMAIL PROTECTED]>
> To: <[EMAIL PROTECTED]>
> Reply-To: [EMAIL PROTECTED]
> Sent from the Internet (Details)
>
>
> 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
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