Leaving a rehabilitation facility against medical advice (AMA) creates significant anxiety for patients and their families, particularly concerning the financial implications. The core question is whether Medicare will cover the services received if a patient chooses to leave before the care team recommends discharge. Understanding the specific coverage rules for a Skilled Nursing Facility (SNF) or Inpatient Rehabilitation Facility (IRF) is essential, as these settings have stricter criteria for continued payment than a general hospital stay.
Defining an AMA Discharge in a Rehabilitation Facility
An AMA discharge occurs when a patient chooses to leave a Medicare-covered facility, such as an SNF or IRF, when the care team determines continued inpatient care is medically necessary. This medical necessity—the requirement for daily skilled services—is the basis for Medicare Part A coverage in these settings.
The procedural steps for an AMA discharge are formal and must be thoroughly documented. The patient must be deemed mentally competent to make the choice, a determination recorded in the medical record. Staff must fully explain the risks and consequences of leaving early, which typically involves the patient signing an AMA form acknowledging their understanding.
The documentation must detail all attempts made to educate the patient about the risks and the recommended plan of care. This record protects the facility from liability should the patient suffer an adverse health event after leaving prematurely. The process ensures the patient’s refusal of further treatment is an informed and voluntary decision.
Immediate Financial Consequences: Medicare Coverage Cessation
Medicare Part A covers SNF and IRF stays only as long as the patient requires daily skilled services that are reasonable and necessary for treatment. Whether Medicare pays for the current stay depends entirely on this concept of “medical necessity.” When a patient decides to leave AMA, they terminate their participation in the required plan of care, invalidating the facility’s ability to provide medically necessary services.
Medicare generally pays for services rendered up to the time the AMA decision is made. However, coverage for the entire day of discharge and any subsequent days is immediately jeopardized. Since the facility is no longer operating under a physician-certified treatment plan, the patient becomes financially responsible for the cost of services rendered on the day of and after the AMA discharge.
The facility must issue formal financial notices, such as an Advance Beneficiary Notice of Noncoverage (ABN), to document the patient’s understanding that Medicare will deny payment for the remainder of the stay. This notice formally transfers financial liability from Medicare to the patient.
The patient loses the right to an expedited appeal of coverage for that specific episode of care because they voluntarily terminated the service. The facility will bill the patient directly for the non-covered portion of the stay, which represents a significant financial liability.
Effect on Future Medicare Benefits and Readmission
A common fear is that leaving a rehabilitation facility AMA will cause a patient to lose their fundamental Medicare eligibility entirely. This is not the case. An AMA discharge does not cause the patient to forfeit their Medicare Part A or Part B benefits for future, unrelated illnesses or injuries. The patient maintains eligibility for all covered services as long as they meet the standard Medicare criteria.
Attempting to return to the same facility shortly after an AMA discharge for the same condition can be problematic. The facility may refuse readmission because the patient previously demonstrated non-compliance with the established plan of care. This history is a factor in the facility’s decision-making process, as they must ensure compliance with treatment standards.
If a patient needs post-hospital rehabilitation later for a new medical issue, the prior AMA discharge does not bar them from coverage. They must meet the standard Medicare requirements, such as a new qualifying three-day inpatient hospital stay before transfer to an SNF. The AMA designation is a clinical and financial coding status for a specific discharge event, not a permanent mark against a patient’s long-term Medicare enrollment.