Temporary Leave

Temporary Leave 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 (1st) 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 (1st) 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.