Nonmedical Leave of Absence: Conditions of Payment

(A) Planned Nonmedical Leave of Absence Duration. MassHealth pays for temporary absences for a planned NMLOA for members in medical respite for up to a total of eight (8) days per medical respite service period. (B ) Payment for Planned NMLOA. For the provider to obtain payment for a NMLOA, the following conditions must be met. (1) The member must request the nonmedical leave prior to taking the leave. (2) In preparation for the NMLOA, the provider's staff must discuss how medical needs will be met during the NMLOA, if applicable, and make arrangements, including packaging and providing medications. (3) During the period of NMLOA, the medical respite provider must hold the same bed and room occupied by the participant at the time the absence began and must not admit any other resident in the participant’s place. (4) The member's medical record maintained by the facility must document: (a) the home address, telephone number, and relationship of the person responsible for the member while the member is absent from the facility, if applicable; and (b) the duration of absence. (C) Unplanned Nonmedical Leave of Absence. MassHealth pays for temporary absences for an unplanned NMLOA for members in medical respite for up to two days. On the day following two consecutive overnight absences, the medical respite provider may discharge the member. (1) When a member’s unplanned NMLOA exceeds two days, MassHealth will not pay the medical respite provider for additional unplanned NMLOA days. (a) The medical respite provider may implement its discharge process for the member on the day following two consecutive overnight absences. (b) If the member seeks to return to the medical respite following the unplanned NMLOA and the member has additional days left in their medical respite service period, the medical respite may readmit the member at the same or a different service location, if there is capacity and the member meets criteria in 130 CMR 458.403(B), and would not need to offer the member the same bed and room to which they were previously assigned. (D) For billing and payment purposes for planned NMLOA days, the day on which a member leaves from a medical respite to their planned destination is the first day of the NMLOA from the medical respite. The day on which a member returns to a medical respite is not a NMLOA day. (E) For billing and payment purposes for unplanned NMLOA days, the day of absence following the first overnight absence from the medical respite service location would be considered the first day of the NMLOA from the medical respite. The day on which a member returns to a medical respite is not a NMLOA day. (F) MassHealth will pay a medical respite for NMLOA days at the rate specified by 101 CMR 321.00: Rates for Homeless Medical Respite Services.