Medical Leave of Absence: Responsibilities of the Hospital for the Transfer of a Member Who Is a

Resident of a Nursing Facility (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 10 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 10 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 10th 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 10-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 10-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 and 450.238. 456.601: Personal Needs Allowance Account MassHealth members have the right to manage their own financial affairs and the nursing facility must not require residents to deposit their personal funds with the facility. However, upon written request by a member, the facility must hold, safeguard, manage, and account for the member’s personal funds deposited with the facility as specified in 130 CMR 456.601 through 456.615. 456.602: Management of the PNA Account If requested by the member, a facility must assume responsibility for the PNA funds of a member. To do so, the facility must obtain and maintain on file a statement of authorization signed by the member or the member’s authorized representative, such as a guardian, conservator, relative, or other responsible person acting on the member’s behalf. The “other responsible person” must not be an employee of the facility or related to an employee of the facility in any way. Once a facility is trustee of a member’s PNA account, it is responsible for the safekeeping of this money and must repay the member for any lost or stolen funds or for any money that cannot be accurately accounted for. 456.603: Autonomy of PNA Accounts (A) If the facility assumes responsibility for a member’s funds, the facility must deposit funds in excess of $50 into a PNA account, that is, an interest-bearing trustee account separate from any of the facility’s operating accounts. (B) The facility must ensure that PNA accounts are not available for any purpose except the personal needs of the member. The funds must not be lent or be used as collateral for a loan for anyone including the facility. 456.604: PNA Recordkeeping Requirements (A) The facility must establish and maintain a system of recordkeeping that ensures a complete and separate accounting of the PNA funds according to generally accepted accounting principles. The system must prevent any commingling of the members’ PNA funds with facility funds or with the funds of any other person other than another resident of the facility. If the facility does not manage the PNA funds for any member, it is not required to maintain such records. (B) (1) The facility must ensure a separate accounting of each member’s PNA funds, maintain a written record of all financial transactions involving the PNA funds, and allow the member or the member’s authorized representative access to the accounting record. (2) The bank-account statements and the general ledger must be in agreement and reconcilable at all times. All bank statements, canceled checks, and supporting documentation relating to the PNA account must be kept in the facility for at least four years from the date of the transaction. (3) All checks or cash received on behalf of the member must be deposited into the PNA account no later than 30 days after the receipt of the money by the facility. (4) The facility must maintain for each member with a PNA account a record of receipts and disbursements separate from other members’ records. The facility must clearly label all PNA receipts and disbursements in the general ledger. (5) At a minimum, all receipts and disbursements must be recorded in the ledger as follows: Receipts Disbursements 1. Date of entry 1. Date of entry 2. Amount 3. Source 2. Specific description (Avoid “misc.,” “personal needs,” etc.) 4. Balance 3. Amount 4. Signature of member or person receiving disbursement 5. Invoice number or date (6) General ledger records must be updated at least once a month. (7) The facility must ensure that funds are available to members in the form of actual cash or check for no less than 10 hours a week and on no less than three days a week. The facility must inform the members of the times when they may receive their money. (8) All money disbursed to or on behalf of a member must be at the request of the member or the member’s representative. The nursing facility may not make any disbursements on behalf of a member for a service that is covered by either Medicare or MassHealth. (9) If a facility disburses money to a member by means of a check, or if the member signs petty cash vouchers, the facility does not need to obtain a signature in the ledger. (10) The facility does not need to itemize cash disbursements to members. (11) The facility must provide the member or the member’s representative every three months and upon the member’s request with an accounting of all financial transactions made on the member’s behalf. 456.605: Petty Cash in the Facility The facility may, if it chooses, maintain a petty cash fund in order to make direct cash distributions to residents. The total of this petty-cash fund must not exceed an amount equal to $5 per member for whom the facility manages a PNA account; however, a maximum of $250 is allowable regardless of the number of members. 456.606: Assurance of Financial Security The facility must purchase a surety bond to assure the security of all personal funds of members deposited with the facility. The facility must keep this bond at the facility. 456.607: Availability of PNA Records to Division Personnel All PNA records, including the accompanying bank statements, canceled checks, and supporting documentation, must be kept in the facility at all times and must be available to Division of Medical Assistance personnel upon request. The request may be made by telephone, in person, or by mail. 456.608: Member Signature If the member cannot sign his or her own name, a staff member or business employee of the facility may sign as witness that the member has received cash from his or her PNA account. 456.609: Notification of Account Balance (A) The facility must notify each member for whom it has established a PNA account when the balance reaches a total of $1800, which is $200 less than the maximum countable assets allowed per member. The notification must state that, if the member’s countable assets exceed the maximum allowable amount of $2000, the member may lose MassHealth eligibility. (B) If the member’s balance exceeds the maximum allowable amount, the member may apply the excess to the cost of care in the facility. 456.610: Availability of PNA Records to Members The facility must, within one working day of a request, allow the member or the member’s authorized representative to examine the PNA records of the member. 456.611: PNA Funds of a Member Transferred to Another Facility If a member is transferred to another facility, all of the member's funds held in trust by the facility must be sent to the new facility within 10 days of the transfer date. 456.612: PNA Funds of a Member Discharged to the Community If a member has been discharged from the facility to the community, he or she must receive his or her bank book back from the facility or receive a check for the balance of his or her PNA account. The amount of the check must reflect the cash held on behalf of the member by the facility plus the bank balance. 456.613: Member Is Transferred to a Hospital and Does Not Return to the Facility If a member is transferred to a hospital and does not return to the facility, the balance of the PNA account must be sent to the member at his or her new address within 10 days after he or she leaves the facility. 456.614: Death of a Member (A) Upon the death of a MassHealth member, the facility must: (1) render an accounting of the member’s PNA funds. The funds must remain at the facility for 30 days after the death of a member to allow for the appointment of an administrator or executor of the estate and for the payment of burial expenses; and (2) notify the next of kin or the person who served as the member’s representative in official business with the facility of any remaining funds, determine whether or not an executor or administrator has been or will be appointed, and explain to the next of kin or the member’s representative how to obtain the funds from the facility. (a) If there is an outstanding balance due on a funeral bill, the funeral home may submit an itemized funeral bill to the facility and the facility may pay the bill from the PNA funds. (b) If an executor or administrator is appointed within 30 days after the death of a member, the facility must send the balance of the PNA account and a final accounting of the member’s account to the administrator or executor of the member's estate. If any payment has been made to the funeral home under 130 CMR 456.414(A)(2)(a), the final accounting must reflect that payment. (B) If any funds still remain in the PNA account after 30 days, the facility must (1) send a check for the balance and a final accounting of the member’s account to the Division of Medical Assistance; and (2) notify the next of kin or the member’s representative of the amount of the funds and the address to which they are being sent and tell them they may apply for the funds, if they are appointed executor or administrator of the member’s estate. (C) A final accounting of the PNA funds must include any transactions that occurred during the previous three months and for the 30 days following the member’s death. If there are no PNA funds, the facility is not required to submit the final accounting; however, the facility must maintain all member records according to 130 CMR 456.604. (D) The facility must include with the returned PNA balance and the accounting the following information: (1) the member's name and social security number; (2) the member’s date of birth and date of death; (3) the name, address, and relationship of the next of kin or the member’s representative ; (4) the name, address, and MassHealth provider number of the facility; and (5) the name and address of the funeral director. 456.615: Annual Accounting to the Division of the PNA Balance (A) Annually, at least by each June 1, an accounting must be made to the Division of the balance of each PNA account. If the facility is not a trustee for any member’s money, it must report this fact by each June 1 to the Division. The accounting to the Division must be submitted on the Statement of MassHealth Member’s Personal Needs Account (PNA-1) and must be dated and signed under the pains and penalty of perjury by the administrator of the facility and mailed to the Division. (B) The accounting must consist of the following: (1) the member's name; (2) the member's social security number; (3) the amount of petty cash held in the facility for the member; (4) the balance held in any individual bank account for the member; (5) the balance held in the trustee account for the member; (6) any other money being held by the facility for the member; and (7) if funds are held in an aggregate trustee bank account, then a copy of the bank statement for that account must be submitted with the accounting. THIS PAGE IS RESERVED.