N.Y. Comp. Codes R. & Regs. tit. 10 § 85.47

Current through Register Vol. 46, No. 50, December 11, 2024

Section 85.47 - Alternate level of care placement-trial discharge

Trial discharges from an acute care hospital to a specialty rehabilitation hospital or a physical medicine and rehabilitation unit of a general hospital shall be in accordance with subdivisions (a), (c) and (d) of this section. Trial discharges from an acute care hospital to mental health facilities licensed under article 31 of the Mental Hygiene Law or to a residential health care facility (RHCF), licensed under article 28 of the Public Health Law shall be in accordance with subdivisions (b), (c) and (d) of this section.

(a) Hospitals shall receive Medicaid reimbursement at the alternate level of care (ALC) rate as established by section 2807-c of the Public Health Law for patients readmitted to such acute care hospitals from a specialty rehabilitation hospital or physical medicine and rehabilitation unit of a general hospital pursuant to the following requirements:

(1) The initial admission to the acute care hospital complied with the requirements of 18 NYCRR 505.20(b)(7).

(2) The purpose of the trial discharge to the specialty rehabilitation hospital or physical medicine and rehabilitation unit of a general hospital was to evaluate the facility's ability to care for that patient.

(3) The patient's acute care hospital medical record and discharge plan fully documented the reason for the trial discharge as well as the possibility of readmission if the trial discharge was unsuccessful.

(4) The specialty rehabilitation hospital or physical medicine and rehabilitation unit of a general hospital determined, in writing, that the facility does not have the capability to meet the patient's assessed needs.

(5) The patient's readmission to the acute care hospital occurred within 30 calendar days from the date of the original discharge to the receiving facility.

(b) Hospitals shall receive Medicaid reimbursement at the alternate level of care (ALC) rate for patients readmitted to such acute care hospitals from mental health facilities licensed under article 31 of the Mental Hygiene Law or RHCF's licensed under article 28 of the Public Health Law pursuant to the following requirements:

(1) The initial admission to the acute care hospital complied with the requirements of 18 NYCRR 505.20(b)(7).

(2) The patient who was discharged by the acute care facility to a nursing home or mental health facility for the purpose of a trial discharge had a documented history, as evidenced in the patient's hospital record, of alcohol or substance abuse, behavioral problems or psychiatric illness and is under treatment for one of these conditions.

(3) The purpose of the trial discharge to the mental health facility or RHCF was to evaluate the facility's ability to care for the patient.

(4) The patient's acute care hospital medical record and discharge plan fully documented the reason for the trial discharge as well as the possibility of readmission if the trial discharge was unsuccessful.

(5) The written evaluation by the mental health facility or the RHCF determined that the facility does not have the capability to meet the patient's assessed needs.

(6) The patient's readmission to the acute care hospital occurred within 30 calendar days from the date of the original discharge to the RHCF or mental health facility except for RHCF residents who assert their rights under section 415.3(h)(1)(iv) of this Title.

(c) The acute care hospital and the receiving facility shall establish, in writing, mutually acceptable arrangements for the implementation of the patient's trial discharge and possible return including but not limited to responsibility for transferring medical records, transportation of patient, education of patient's family regarding trial discharge process, and notification between facilities if the patient is to be returned to the acute care hospital.

(d) Nothing in this section shall be construed to limit in any manner, patients'or residents' rights as guaranteed to hospital, RHCF, and mental health facility patients and residents by applicable law or regulation.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 85.47