Current through Register 1531, September 27, 2024
(A) When a member is transferred from a
nursing facility to a hospital, the nursing facility must (1) provide the
member and the member's authorized or legal representative with notice of the
facility's bed-hold policy, including the member's right to return and resume
residence in the facility;
(2) provide the
member and the member's authorized or legal representative with notice of the
transfer that complies with the requirements set forth in
130
CMR 456.701 and
456.702;
(3) document the date and time of the
transfer in the member's record;
(4) automatically reserve the same bed and
room occupied by the member at the time the absence began for the member until
the close of business on the second working day of the member's hospital
stay;
(5) contact the admitting
hospital and obtain the estimated length of stay by the close of business on
the second working day of the member's hospital stay and document the estimated
length of stay in the member's medical record;
(6) if the estimated length of stay is 20
consecutive days or fewer, reserve the same bed and room occupied by the member
at the time the absence began for the balance of the actual length of stay not
to exceed 20 consecutive days from the date of admission to the
hospital;
(7) ensure that for each
day that a bed is reserved the bed is not occupied; and
(8) if the hospital advises the nursing
facility that the estimated length of stay exceeds 20 consecutive days, the
nursing facility cannot bill MassHealth for a medical leave of absence from the
date of such notification by the hospital.
(B) Notwithstanding
130
CMR 456.426(A), MassHealth
does not pay a nursing facility for reserving a bed for a member
(1) after the second working day of the
member's stay if the nursing facility has failed to obtain the estimate of the
length of stay from the hospital;
(2) if the member has notified the nursing
facility in writing that the member does not wish to return to the
facility;
(3) for any consecutive
medical leave of absence day in excess of the 20 days from the date of transfer
from the nursing facility;
(4) the
day on which a member is transferred back to a nursing facility or is
discharged from the hospital to a non-institutional setting; and
(5) for any MLOA in cases where the member is
transferred from a nursing facility to a hospital and transferred back to the
nursing facility on the same calendar day.
(C) When a member is transferred from one
inpatient hospital to another inpatient hospital during the medical leave of
absence, the nursing facility must continue to reserve for the member the same
bed and room occupied by the member at the time the absence began for up to the
20th day of the member's absence from the nursing
facility as long as the member continues to require a medical leave of absence
and the conditions in
130
CMR 456.426(A) are met. A
transfer from one hospital to another continues the 20-day period initiated on
the first day the member originally was transferred from the nursing facility
for the original medical leave of absence, and does not initiate another 20-day
period.
