The contractor is not required to discharge (move out) and readmit a resident for absences of less then twenty-one consecutive days. The contractor must:
(1) Note an absence in a resident's record when a resident is absent from the boarding home for more than seventy-two consecutive hours;
(2) Obtain department approval for payment for social leave in excess of eighteen calendar days per year;
(3) Notify the department within one working day whenever the resident:
(a) Is hospitalized;
(b) Is discharged to another boarding home, nursing home or other health care facility;
(c) Dies; or
(d) Is missing from the boarding home and his or her whereabouts are unknown.
(4) Include the department's case manager in the development of a discharge (move out) plan, and have the case manager approve the plan before any required notice of discharge is issued to the resident, except in an emergency;
(5) Notify the medicaid resident of the boarding home's policies regarding bed-holds, consistent with subsections (6) and (7) of this section and WAC 388-105-0045
as soon as possible before, or as soon as practicable following hospitalization or discharge to a nursing home. The notification must include information concerning:
(a) Options for bed-hold payments, and
(b) Rights to return to the boarding home.
(6) Retain a bed or unit for a medicaid resident who is hospitalized or temporarily placed in a nursing home for up to twenty days when the medicaid resident is likely to return to the boarding home and the department makes payment to the boarding home for holding the bed or unit consistent with WAC 388-105-0045
. If, prior to the end of the twenty days, the department determines, or the contractor determines and the department concurs, that the medicaid resident will likely not return to the boarding home:
(a) The department must terminate the bed-hold payment; and
(b) The contractor may rent that bed or unit to another resident.
(7) Not seek third-party payment for the first twenty days of retaining the bed for a medicaid resident who is hospitalized or discharged to a nursing home and for whom the department is making a bed hold payment consistent with WAC 388-105-0045
(a) The contractor may seek third-party payment consistent with RCW 18.20.290
and chapter 388-105
WAC to hold a bed or unit for the time following the first twenty days of a medicaid resident's absence for hospitalization or nursing home care.
(b) If third-party payment is not available, the medicaid resident may return to the first available and appropriate bed or unit if the medicaid resident:
(i) Continues to meet the boarding home's admission criteria; and
(ii) Chooses to return to the boarding home.
[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-110-100, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.070, and chapter 74.39A RCW. 04-16-063, § 388-110-100, filed 7/30/04, effective 9/1/04. Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-[18.88A.]240 and70.129.040 . 96-11-045 (Order 3979), § 388-110-100, filed 5/8/96, effective 6/8/96.]