Current through Register 1531, September 27, 2024
(A) The Division will pay a nursing facility
to reserve a bed during a member's medical leave of absence if the admitting
hospital meets the requirements of 130 CMR 435.424(B).
(B) Whenever a member is admitted to a
hospital from a nursing facility, the hospital must comply with the following
requirements.
(1) The hospital must ensure
that the Division's nursing facility bed reservation form for medical leave of
absence (hereafter referred to as "the bed reservation form") has been received
from the nursing facility.
(2) 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;
(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;
and
(c) complete the appropriate
section of the bed reservation form, according to the instructions provided on
the form.
(3) When the
member's estimated length of stay will be ten 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.
(4) When the member's estimated length of
stay exceeds ten 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 tenth 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;
(3) immediately notify the nursing facility
by telephone of the revised estimated length of stay, in accordance with 130
CMR 435.424(B); and
(4) complete
the appropriate section of the bed reservation form, if applicable, according
to the instructions provided on the form.
(D) If the member is transferred within the
ten-day medical leave-of-absence period to another hospital:
(1) the transferring hospital must:
(a) notify the nursing facility immediately
by telephone; and
(b) complete the
appropriate section of the bed reservation form, according to the instructions
provided on the form; and
(2) the receiving hospital must comply with
all the requirements stated in 130 CMR 435.424.
(E) If the member is transferred within the
ten-day medical leave-of-absence period to another nursing facility or
noninstitutional setting, or if the member dies, the hospital must:
(1) notify the original nursing facility
immediately by telephone; and
(2)
complete the appropriate section of the bed reservation form according to the
instructions provided on the form.
(F) Failure by the hospital to comply with
any of the requirements set forth in 130 CMR 435.424 may result in
administrative fines in accordance with the Division's administrative and
billing regulations at
130 CMR
450.237: Overpayments:
Determination and 450.238: Sanctions:
General.
