Section 456.426 - Medical Leave of Absence: Conditions of Payment(A) When a member is transferred from a nursing facility to a hospital, the nursing facility must (1) provide the member and the member's authorized or legal representative with notice of the facility's bed-hold policy, including the member's right to return and resume residence in the facility; (2) provide the member and the member's authorized or legal representative with notice of the transfer that complies with the requirements set forth in 130 CMR 456.701 and 456.702;(3) document the date and time of the transfer in the member's record;(4) automatically reserve the same bed and room occupied by the member at the time the absence began for the member until the close of business on the second working day of the member's hospital stay;(5) contact the admitting hospital and obtain the estimated length of stay by the close of business on the second working day of the member's hospital stay and document the estimated length of stay in the member's medical record;(6) if the estimated length of stay is 20 consecutive days or fewer, reserve the same bed and room occupied by the member at the time the absence began for the balance of the actual length of stay not to exceed 20 consecutive days from the date of admission to the hospital;(7) ensure that for each day that a bed is reserved the bed is not occupied; and(8) if the hospital advises the nursing facility that the estimated length of stay exceeds 20 consecutive days, the nursing facility cannot bill MassHealth for a medical leave of absence from the date of such notification by the hospital.(B) Notwithstanding 130 CMR 456.426(A), MassHealth does not pay a nursing facility for reserving a bed for a member (1) after the second working day of the member's stay if the nursing facility has failed to obtain the estimate of the length of stay from the hospital;(2) if the member has notified the nursing facility in writing that the member does not wish to return to the facility;(3) for any consecutive medical leave of absence day in excess of the 20 days from the date of transfer from the nursing facility;(4) the day on which a member is transferred back to a nursing facility or is discharged from the hospital to a non-institutional setting; and(5) for any MLOA in cases where the member is transferred from a nursing facility to a hospital and transferred back to the nursing facility on the same calendar day.(C) When a member is transferred from one inpatient hospital to another inpatient hospital during the medical leave of absence, the nursing facility must continue to reserve for the member the same bed and room occupied by the member at the time the absence began for up to the 20th day of the member's absence from the nursing facility as long as the member continues to require a medical leave of absence and the conditions in 130 CMR 456.426(A) are met. A transfer from one hospital to another continues the 20-day period initiated on the first day the member originally was transferred from the nursing facility for the original medical leave of absence, and does not initiate another 20-day period.Amended by Mass Register Issue 1505, eff. 10/1/2023.