Legal Resources | | T22 51535
Subdivision 1. California Medical Assistance Program. Chapter 3. Health Care Services. Article 7. Payment for Services and Supplies (Refs & Annos). Leave of Absence
(a) Payment may be made to skilled nursing facilities, swing bed facilities, intermediate care facilities, intermediate care facilities for the developmentally disabled, intermediate care facilities for the developmentally disabled/habilitative and intermediate care facilities for the developmentally disabled-nursing, for patients who are on approved leave of absence. Payment for leave of absence shall not exceed the maximum number of days per calendar year indicated below:
(1) Developmentally disabled, developmentally disabled habilitative and developmentally disabled-nursing beneficiaries: 73 days.
(2) Patients in a certified special treatment program for mentally disordered persons, or patients in a mental health therapeutic and rehabilitative program approved and certified by a local mental health director: 30 days.
(3) All other patients: 18 days. Up to 12 additional days of leave per year may be approved when the request for additional days of leave is in accordance with the individual patient care plan and appropriate to the physical and mental well-being of the patient.
(b) Leave of absence may be approved for:
(1) A visit with relatives or friends.
(2) Participation by developmentally disabled, developmentally disabled habilitative and developmentally disabled-nursing beneficiaries in an organized summer camp for developmentally disabled persons.
(c) All of the following requirements shall be met:
(1) Written approval and instructions for leave of absence shall be provided as follows:
(A) In the individual program plan for developmentally disabled patients in intermediate care facilities for the developmentally disabled, developmentally disabled habilitative and developmentally disabled-nursing.
(B) In the individual patient care plan for patients in a certified special treatment program for mentally disordered persons, or patients in a mental health therapeutic and rehabilitative program approved and certified by a local mental health officer.
(C) By the patient's attending physician for all other patients and in the individual patient care plan for those leaves involving the up to 12 additional days described in (a)(3).
(2) The facility shall hold the bed vacant during leave.
(3) The day of departure shall be counted as one day of leave and the day of return shall be counted as one day of inpatient care.
(4) Leave shall be terminated on the day of the death of the patient. Leave shall be terminated if the patient is admitted as an inpatient to any other facility, or if the patient exceeds the approved period of leave of absence and is determined to be absent without leave.
(5) Payment shall not be made for the last day of leave if the patient dies or fails to return from leave within the period of approved leave.
(6) Payment shall not be made for the period of leave of absence if the patient is discharged within 24 hours of return from leave, or if the patient is discharged while on leave of absence, except as provided in (c)(5).
(7) Failure to return from leave of absence within the approved period shall not invalidate an approved treatment authorization request. There shall be no requirement to file a new treatment authorization request if the patient fails to return from leave within the approved period.
(8) Facility claims shall identify the inclusive dates of leave.
(9) The patient's records maintained in the skilled nursing facility, intermediate care facility, intermediate care facility for the developmentally disabled, intermediate care facility for the developmentally disabled habilitative, or intermediate care facility for the developmentally disabled-nursing shall show the address of the intended leave destination and the inclusive dates of leave.
(d) Payment to skilled nursing facilities, swing bed facilities, intermediate care facilities, intermediate care facilities for the developmentally disabled, intermediate care facilities for the developmentally disabled-habilitative, and intermediate care facilities for the developmentally disabled-nursing for patients who are on approved leave of absence shall be at the appropriate facility daily rate less the amount specified in the chart below for raw food costs, except for state operated institutions.
Leave of Absence
Effective Rate Year
2004-05 2005-06 2006-07
$5.07 $5.18 $5.30
Authority cited:
Health and Safety Code 20
Welfare and Institutions Code 10725
Welfare and Institutions Code 14105
Welfare and Institutions Code 14108
Welfare and Institutions Code 14108.1
Welfare and Institutions Code 14108.2
Welfare and Institutions Code 14124.5
Health and Safety Code 1275.3
Reference:
Welfare and Institutions Code 14108
Welfare and Institutions Code 14108.1
Welfare and Institutions Code 14108.2
Welfare and Institutions Code 14109.5
Welfare and Institutions Code 14110.1
Health and Safety Code 1275.3
Statutes of 2004, Chapter 208, Items 4260-101-0001 and 4260-101-0890
Statutes of 2005, Chapter 38, Items 4260-101-0001 and 4260-101-0890
Statutes of 2006, Chapter 48, Items 4260-101-0001 and 4260-101-0890
(Amended by Register 2014, No. 21.)