Current through September 24, 2024
A. The Division of
Medicaid defines temporary leave as a temporary absence for one (1) or more
calendar days the resident is out of the nursing facility for:
1. A home/therapeutic temporary leave.
a) The temporary leave is defined as:
1) Eight (8) consecutive hours or more during
the day excluding:
(a) Dialysis,
(b) Chemotherapy,
(c) Physical therapy,
(d) Speech therapy,
(e) Occupational therapy, or
(f) Medical treatments that occur two (2) or
more days per week.
2)
An absence at twelve midnight (12 a.m.), or
3) A hospital observation stay of eight (8)
or more consecutive hours.
b) The first (1
st) day of a temporary leave begins the
calendar day the resident left the nursing facility.
c) The end of the home/therapeutic temporary
leave is the calendar day:
1) The resident
returns to the nursing facility,
2) After the resident returns if the resident
was out of the nursing facility for eight (8) or more hours as of midnight (12
a.m.) on the day the resident returned to the nursing facility,
3) The resident returns to the nursing
facility after a hospital observation stay of eight (8) or more consecutive
hours, or
4) The resident is
admitted to an inpatient hospital acute care stay from an observation stay.
2. An
inpatient hospital temporary leave.
a) The
temporary leave is defined as an admission to the inpatient hospital for
continuous acute care.
b) The
first (1st) day of a temporary leave begins the calendar day the resident is
admitted to the inpatient hospital for continuous acute care.
c) The end of the temporary leave is the
calendar day the resident returns to the nursing facility.
B. Before the resident
departs on home/therapeutic or inpatient hospital temporary leave, the nursing
facility must provide a written notice to the resident and/or family member or
legal representative explaining the nursing facility's temporary leave,
bed-hold and resident return policies.
1. The
written notice must define the period of time during which the resident is
permitted to return and resume residence in the nursing facility.
2. The written notice must also state that if
the resident's absence exceeds the Division of Medicaid's bed-hold limit the
resident will be readmitted to the nursing facility upon the first availability
of a semi-private bed if the resident still requires the services provided by
the nursing facility.
C. The Division of Medicaid covers up to
fifteen (15) consecutive days of home/therapeutic temporary leave per one (1)
absence for up to a total of forty-two (42) days per state fiscal year, which
begins July 1 and ends June 30 of the following calendar year, in addition to
certain holidays.
1. The holidays included in
home/therapeutic temporary leave are:
a)
Christmas Day,
b) The day before
Christmas Day,
c) The day after
Christmas Day,
d) Thanksgiving
Day,
e) The day before
Thanksgiving Day, and
f) The day
after Thanksgiving Day.
2. All home/therapeutic temporary leave days
must be approved by the attending physician.
3. Home/therapeutic temporary leave includes
the resident's absence for:
a) Eight (8) or
more consecutive hours during the calendar day or at midnight (12 a.m.),
b) A hospital observation stay of
eight (8) or more consecutive hours when the resident is not admitted for an
inpatient hospital acute care stay, or
c) Outpatient treatments except for:
1) Dialysis,
2) Chemotherapy,
3) Physical therapy,
4) Speech therapy,
5) Occupational therapy, or
6) Medical treatments that occur two (2) or
more days per week.
4. The nursing facility must reserve the
resident's bed in anticipation of the resident's return and cannot fill the
resident's bed with another resident during the covered period of
home/therapeutic temporary leave.
5. Nursing facilities cannot refuse to
readmit a resident from home/therapeutic temporary leave if the facility has
billed for home/therapeutic leave days and the resident still requires the
services provided by the nursing facility.
6. After a fifteen (15) day home/therapeutic
temporary leave period has been exhausted, a new leave of absence for
home/therapeutic temporary leave does not begin until the resident has returned
to the nursing facility for twenty-four (24) hours or longer.
D. The Division of Medicaid covers
fifteen (15) consecutive days of inpatient hospital temporary leave per each
absence for continuous acute care during an inpatient hospital stay.
1. The period of leave is determined by
counting the first (1
st) day of leave as the calendar day the
resident was admitted to an inpatient hospital for continuous acute care after
leaving the nursing facility.
2.
There is no maximum number of inpatient hospital temporary leave days per each
state fiscal year.
3. Inpatient
hospital temporary leave applies to acute care hospital stays in a licensed
hospital including geriatric psychiatric units.
4. Inpatient hospital temporary leave does
not apply if the resident is admitted for:
a)
Hospital observation stays,
b)
Medicare-only skilled nursing facility (SNF) stays, or
c) Swing-bed stays.
5. After a fifteen (15) day inpatient
hospital temporary leave period has been exhausted, a new leave of absence for
acute hospitalization does not begin until the resident has returned to the
nursing facility for a period of twenty-four (24) hours or longer.
6. As long as the resident has remained in
the inpatient hospital receiving acute care and returns to any Medicaid
certified nursing facility, the nursing facility is not required to complete a
new Pre-Admission Screening (PAS) form.
7. Nursing facilities cannot refuse to
readmit a resident from inpatient hospital temporary leave if the facility has
billed for inpatient hospital leave days and still requires the services
provided by the nursing facility.
8. The nursing facility must reserve the
resident's bed in anticipation of the resident's return and cannot fill the
resident's bed with another resident during the covered period of inpatient
hospital temporary leave.
42 C.F.R. §
447.40; Miss. Code Ann. §§
43-13-117,
43-13-121.