<<QUOTE
The âpractical matterâ 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 patientâs 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, âDuration of Covered Inpatient Services,â Â20.1.2, for counting inpatient days during a leave of absence.)
A conservative approach to retain the presumption for limitation of liability may lead a facility to notify patients that leaving the facility will result in denial of coverage. Such a notice is not appropriate. If a SNF determines that covered care is no longer needed, the situation does not change whether the patient actually leaves the facility or not.
>>END QUOTE
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Re: Medicare LOA
Date: 5/3/2004 3:14:55 PM Pacific Daylight Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Oh, boy, do I know the answer to this. Check out F 151, Residents' Rights.
We were cited on this on one of our 5 surveys in the past 6 months.
Our current policy is that Med A res can go out on LOA as long as it is
prearranged with administration, MD order is written, and is not a daily
occurrence. Also, whatever their skilled service must continue to be
provided. (Ex.. they must receive scheduled therapy session or skilled
nursing service prior to going out for LOA)
HS
Holly F. Sox, RN, RAC-C
Clinical Editor
Careplans.com
[EMAIL PROTECTED] www.careplans.com
----- Original Message -----
From: "Berenguer, Jackie" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Monday, May 03, 2004 5:10 PM
Subject: Medicare LOA
Does anybody know of a regulation that Medicare patients are not to go on
LOA except for MD appt? As I can remember from the last seminar I went to
here in California, Medicare patients can go LOA if they want, right?
Thanks.
