Current through Register Vol. 43, No. 39, September 26, 2024
(a) Payment shall
be available for nursing facility residents, excluding those on planned
temporary stays, for days for which it is necessary to reserve a bed in a
nursing facility (NF) or nursing facility for mental health (NF-MH) when the
resident is absent for any of the following reasons:
(1) Admission to a hospital for acute
conditions;
(2) therapeutically
indicated home visits with relatives and friends; or
(3) participation in any state-approved
therapeutic or rehabilitative program.
(b) In order for payment to be available, the
following requirements shall be met when a bed is reserved in a nursing
facility or nursing facility for mental health because of a resident's
hospitalization for acute conditions:
(1) The
period of hospitalization shall not exceed either of the following limits:
(A) 10 days for each single hospital stay for
an acute condition; or
(B) 21 days
for residents from a nursing facility for mental health for each admission to a
state mental institution or admission to a psychiatric ward in any of the
following:
(i) A general hospital;
(ii) a private psychiatric hospital; or
(iii) a veterans administration
medical center.
(2) The resident shall intend to return to
the same facility after hospitalization.
(3) The hospital shall provide a discharge
plan for the resident.
(4)
Reimbursement shall not be made to reserve a bed in a swing bed hospital if a
nursing facility will be reimbursed for the same day to reserve a bed for the
resident's return from the hospital.
(c) The resident's plan of care shall provide
for the non-hospital-related absence.
(1)
Payment for non-hospital-related reserve days for eligible residents in nursing
facilities for mental health shall not exceed 21 days per calendar year,
including travel. If additional days are required to obtain or retain
employment, participate in a job readiness training program, or alleviate a
severe hardship, the requesting party shall send a request for additional days
and supporting documentation to the fiscal agent for approval or disapproval.
(2) Payment for
non-hospital-related reserve days for all eligible residents in nursing
facilities shall not exceed 18 days per calendar year, including travel. If
additional days are required to alleviate a severe hardship, the requesting
party shall send a request for additional days and supporting documentation to
the fiscal agent for approval or disapproval.
(d) This regulation shall not prohibit any
resident from leaving a facility if the resident so desires.
(e) Payments made for unauthorized reserve
days shall be reclaimed by the agency.
(f)
(1)
Before any routine absence by residents, the provider shall notify the local
agency office.
(2) In case of
emergency admission to a hospital, the provider shall notify the local agency
office not later than five working days following admission.
(g) Payment for reserve days shall
be approved except when the absence is longer than 10 hospital days for NF or
NF-MH residents or 21 hospital days for NF-MH residents who enter either of the
following:
(1) A state mental hospital; or
(2) a psychiatric ward in any of
the following:
(A) A general hospital;
(B) a private psychiatric
hospital; or
(C) a veterans
administration medical center.
