Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 415.000 - Acute Inpatient Hospital Services
Section 415.425 - Medical Leave-of-absence: Responsibilities of the Hospital for the Transfer of a Recipient who is a Resident of a Nursing Facility

Universal Citation: 130 MA Code of Regs 130.415

Current through Register 1531, September 27, 2024

(A) Effective for dates of service on or after July 1, 2000, the Division will pay a nursing facility to reserve a bed during a member's medical leave-of-absence in accordance with the terms and conditions of 130 CMR 415.425(B).

(B) Whenever a member is admitted to a hospital from a nursing facility, the hospital must comply with the following requirements.

(1) Not later than the second working day of the member's hospital stay, the hospital must:
(a) review the member's medical record to determine the member's estimated length of stay; and

(b) notify the nursing facility by telephone of the estimated number of days of the stay and document in the member's medical record the date of such telephone notification to the nursing facility.

(2) When the member's estimated length of stay will be 20 consecutive days or less, the facility must reserve a bed for the same number of days and the hospital must so notify its discharge-planning unit.

(3) When the member's estimated length of stay exceeds 20 consecutive days, the facility must not reserve a bed and the hospital must so notify its discharge-planning unit.

(C) The hospital must review the member's medical status on an ongoing basis. Whenever a change in the member's medical status occurs before the 20th day of the hospital stay, the hospital must:

(1) review the member's medical record;

(2) revise the estimated length of stay if the member's change in medical status so requires; and

(3) immediately notify the nursing facility by telephone of the revised estimated length of stay, in accordance with 130 CMR 415.425(B).

(D) If the member is transferred within the 20-day medical leave-of-absence period to another hospital,

(1) the transferring hospital must notify the nursing facility immediately by telephone; and

(2) the receiving hospital must comply with all the requirements stated in 130 CMR 415.425.

(E) If the member is transferred within the 20-day medical leave-of-absence period to another nursing facility or noninstitutional setting, or if the member dies, the hospital must notify the original nursing facility immediately by telephone.

(F) Failure by the hospital to comply with any of the requirements set forth in 130 CMR 415.425 may result in administrative fines, in accordance with the Division's administrative and billing regulations at 130 CMR 450.237 and 450.238.

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