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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsApril 2016

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Regulatory Flexibility Act Form

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§1919(c)(2)(D) of the Social Security Act, Notice of bed hold policy and readmission
42 CFR §440.40, Payment for reserving beds in institutions
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
42 CFR §483.12, Admission, transfer and discharge rights
Payments for Reserving Beds in Institutions
Federal Fiscal Year 20161

1

Payment will be made for reserving beds in long-term care (LTC) facilities for recipients during their temporary absence for the following purposes:
5. 2. For leaves of absence up to 18 eighteen (18) days per calendar year as provided for in the recipient's plan of care.
3. If a recipient's physical condition is being negatively impacted by their his or her emotional need to be in a family setting, prior approval may be obtained for a waiver of the 18-day eighteen-day leave of absence limitation (for other than acute care hospitalization) from the Title XIX Medical Consultant in order to allow the patient more time to visit with his or her family, as long as such absences are provided for in the recipient's written plan of care.
To obtain approval, a written request must be submitted by the nursing home long-term care facility to the Nursing Home Long-Term Care Coordinator and must include:
1. a. reason Reason for the request;
2. b. medical Medical summary;
3. c. statement Statement from the nursing home's LTC facility's medical director regarding the medical necessity of the patient being absent from the home facility in excess of 18 eighteen (18) days per year;
4. d. anticipated Anticipated frequency of absence.; and
e. Number of days the recipient was absent from the LTC facility during the previous six-month period.
20650 Temporary Absence from Nursing a Long-Term Care Facility
42 CFR §447.40
20650.1 20650.2 Temporary Absence from Nursing a Long-Term Care Facility for Reasons Other Than Hospitalization
20650.2.1 A recipient may be absent from the nursing a long-term care facility for reasons other than hospitalization for a period of 18 eighteen (18) days per year without interruption of payment to the nursing long-term care facility, as long as such absences are provided for in the recipient's plan of care.
20650.2.2 If a recipient's physical condition is being negatively impacted by his or her emotional need to be in a family setting, prior approval may be obtained for a waiver of the 18-day eighteen-day leave of absence limitation (for other than acute care hospitalization) from the Title XIX Medical Consultant in order to allow the patient more time to visit with his or her family.
To obtain approval, a written request must be submitted by the nursing long-term care facility to the Long-Term Care Coordinator and must include:
20650.2.2.1 reason Reason for the request;
20650.2.2.2 medical Medical summary;
20650.2.2.3 statement Statement from the nursing LTC facility's medical director regarding the medical necessity of the patient being absent from the nursing LTC facility in excess of 18 eighteen (18) days per year;
20650.2.2.4 anticipated Anticipated frequency of absence; and
20650.2.2.5 number Number of days the recipient was absent from the nursing LTC facility during the previous six month six-month period.
If the approval is given, the 18-day eighteen-day restriction will be waived for six (6) months from the date of approval. Any request for a waiver after the six month six-month limit must be resubmitted and approved for payments to be continued.
Last Updated: December 31 1969 19:00:00.
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