Can a resident of a nursing home with Medicaid benefits leave the facility for an overnight visit that is a non-hospitalization leave

Medicaid planning can be very tricky – with Medicaid legislation in constant fluctuation, with policies, waiting periods and maximum asset/income levels becoming stricter – planning is crucial. Our Certified Elder Law Attorneys at Littman Krooks have put together a new series of entries that address some of the more frequently asked questions we’ve heard about Medicaid:

  • Can a resident of a nursing home with Medicaid benefits leave the facility for an overnight visit that is a non-hospitalization leave?

Medicaid Guidelines regulate bed reservation policies at nursing homes. A leave of absence is defined as an overnight absence (such as a visit with relatives and friends) or a leave to participate in medically acceptable therapeutic or rehabilitative plans of care. A leave of absence is considered to be non-inclusive of hospitalization time. Under Medicaid rules, Medicaid allows for up to ten (10) days in a 12-month period of time for a non-hospital leave. Medicaid is reimbursed for ninety-five (95%) of the Medicaid rate, otherwise payable to the facility for the services provided on behalf of the person (DAL/DQS #05-13).

  • What if the nursing home facility provides the patient with a bed hold waiver form?

At many facilities, if a bed hold waiver form is not signed, a patient will be discharged and their room will not be held during a leave of absence. A bed hold waiver form, when signed, permits the nursing home to hold the patient’s room during any absence that the resident may have from the facility. However, oftentimes, signing this agreement gives the nursing home permission to bill the resident privately, along with the NYS tax assessment, for every day that the resident is absent. Residents should carefully read any agreements prior to signing.

  • What if a Medicaid-eligible resident’s leave of absence exceeds the number of Medicaid reimbursable days?

For Medicaid residents that do sign the bed hold waiver agreement, residents should not be charged for any absences as Medicaid should be billed for the days absent as long as the patient falls within the 10 day rule within 12 months. If a Medicaid-eligible resident’s leave of absence exceeds the number of Medicaid reimbursable days, the facility may charge privately to the bed holder. The Department does not regulate the amount charged. Residents should inquire if their nursing home is not seeking reimbursement from Medicaid for these charges.

Summary:

  • Medicaid allows for up to ten (10) days in a 12-month period of time for a non-hospital leave;
  • A bed hold waiver form, when signed, oftentimes permits the nursing home to hold the patient’s room during any absence that the resident may have from the facility;
  • For any Medicaid residents that do sign the bed hold waiver agreement, Medicaid should be billed for the days absent as long as the patient falls within the 10 day rule within 12 months;
  • If a Medicaid-eligible resident’s leave of absence exceeds the number of Medicaid reimbursable days, the facility may charge privately to the bed holder. The Department does not regulate the amount charged.

For more information on medicaid planning, elder law, estate planning, veterans’ benefits, special needs planning or special education advocacy, visit our website at www.littmankrooks.com. Have a question? Contact us at info@littmankrooks.com.

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