Medical Leave of Absence: Conditions of Payment

(A) When a member is transferred from a medical respite service location for a MLOA , the medical respite provider must: (1) provide the member and the member’s authorized or legal representative with notice of the medical respite provider’s bed-hold policy, including the member’s right to return; (2) provide the member and the member’s authorized or legal representative with notice of the MLOA; (3) provide the member’s MassHealth managed care plan or Community Partner, if applicable, with notice of the MLOA; (4) document the date and time of the beginning of the MLOA in the member’s record; (5) automatically reserve the same bed and room occupied by the member at the time the leave of absence began for the member for the period of the MLOA, for up to 15 days, unless the health needs of the member following return require a change to a different bed and/or room, in which case the medical respite provider shall reserve a more appropriate bed and room for the member; and (6) ensure that for each day that a bed is reserved the reserved bed is not occupied. (B) Notwithstanding 130 CMR 458.416(A), MassHealth does not pay a medical respite for reserving a bed for a member: (1) if the member has notified the medical respite provider in writing that the member does not wish to return to the medical respite setting; (2) for any MLOA day in excess of the 15 days from the date of transfer from the medical respite; (3) for the day on which a member is transferred back to a medical respite or is discharged to a non-institutional setting, as such day should be billed as a medical respite service day; and (4) for any MLOA in cases where the member is transferred from a medical respite to a hospital and transferred back to the medical respite on the same calendar day, as such day should be billed as a medical respite service day. (C) When a member is transferred from one medical facility to another medical facility during the MLOA, the medical respite provider must continue to reserve for the member the same bed and room occupied by the member at the time the MLOA began as long as the member continues to require a MLOA and the conditions in 130 CMR 458.415: Medical Leave of Absence Introduction through 130 CMR 458.418: Medical Leave of Absence: Failure to Readmit are met. A transfer from one medical facility to another continues the MLOA period initiated on the first day the member originally was transferred from the medical respite for the original MLOA and does not initiate another 15-day period.