Medical Leave of Absence: Failure to Readmit

(A) When a nursing facility is notified that the member is ready to return to the facility, the nursing facility must readmit the member following a medical leave of absence. If the nursing facility does not allow the member to be readmitted following hospitalization or other medical leave of absence, the nursing facility’s failure to readmit the member is deemed a transfer or discharge. If the nursing facility does not readmit, it must provide the member and the member’s authorized or legal representative with a notice explaining its decision not to readmit the member at the time such determination is made. The notice must comply with the requirements set forth in 130 CMR 456.701. (B) A nursing facility that fails to readmit a member who requires nursing facility services or otherwise violates these provisions may be subject to overpayment or sanction action under 130 CMR 450.000: Administrative and Billing Regulations.