2582 Temporary Absence from Nursing Home

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Temporary Absence from Nursing Home

Effective Date:

February 2020

Chapter:

2575

Policy Number:

2582

Previous Policy Number(s):

MT 7

Updated or Reviewed in MT:

MT-58

Requirements

DMA will continue to make a vendor payment for a limited time on an individual residing away from the nursing home (NH) due to hospitalization or a home visit.

Basic Considerations

DMA will continue to make a vendor payment for the actual number of days a bed is held for a recipient while hospitalized, up to a maximum of seven days per hospitalization.

Arrangements can be made between the NH and the recipient to hold the bed longer than seven days.

DMA will continue to make a vendor payment when a recipient visits away from the NH for a specified number of days.

The following chart specifies the number of days DMA will continue the vendor payment to the NH during a home visit or hospitalization.

Chart 2582.1 – Temporary Absence from NH for a Home Visit
IF the recipient is THEN the Vendor Payment will continue for

A nursing home resident,

a maximum number of 8 days per calendar year.

a potential Alternative Health Services candidate under CCSP

up to 7 days for a trial visit in a Personal Care Home for a maximum of 2 visits per year.

in the hospital

up to 7 days
A day is defined as an overnight stay away from the NH. A DFCS County Department that becomes aware that a facility is consistently disregarding the guidelines concerning absence should contact the state Medicaid Unit through their supervisor.

Procedures

Medicaid will pay the NH for up to 7 hospital bed hold days when an A/R goes into the hospital and is expected to return to the nursing home.

When a recipient remains in the hospital for more than 7 days, assume that the NH has made arrangements with the recipient or family to hold the bed beyond 7 days.

It is not necessary for the nursing home to send a discharge DMA-59 to DFCS if the A/R is discharged to the hospital and readmitted to the same nursing home, even if the hospital stay exceeds seven days.