When an individual who lives in a Skilled Nursing Facility (SNF) is approved for Medicaid, a “Medicaid number” is assigned to that individual. This is the number that will be used for billing purposes by the nursing home, the pharmacy, the hospital, and other health care providers. The MLTSS Medicaid program pays for the skilled nursing facility at a specific daily rate as long as the individual is in the facility. If the resident is temporarily transferred to a hospital, the facility will continue to be paid for the bed for ten days despite the fact that the resident isn’t actually there; in fact the facility is required to hold the bed for ten days at no charge to the resident.

The resident also has the right to be absent from the facility for up to 24 nights per year without loss of Medicaid benefits. This is called “therapeutic leave” and is broadly intended to encompass things like time with family members or even a trial run of home care to see whether discharge to the community might be viable. Therapeutic leave must be authorized by the resident’s physician. The right to therapeutic leave is within the federal regulations; the states decide the actual number of days. “One day” includes the overnight. New Jersey’s regulations allow 24 days of leave. Unused days cannot be carried over into a new calendar year.

Of course, if the family is contemplating a therapeutic leave, it would be very important to go over the details of the daily care plan with the treatment team in the nursing home, to arrange for the necessary prescriptions and over the counter products, and to make sure that there are adequate home health care/aide services available. Each skilled nursing facility has to have specific procedures for accommodating requests for therapeutic leave, so make sure you give yourself enough time to work out the details before taking the resident out for therapeutic leave.

Call us for advice and representation regarding rights of nursing home residents and long term care planning …… (732) 382-6070