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.