SECTION 46.49. Institutional Leave

(a) Institution. An institution is defined as a hospital, nursing facility, state school, state hospital, or intermediate care facility serving persons with mental retardation or a related condition.

(b) Institutional leave. Institutional leave is when clients are absent from the facility because they temporarily enter an institution.

(c) Bedhold. The facility must hold the client's bed:

(1) for a Community Care for Aged and Disabled (CCAD) Residential Care (RC) client for:

(A) 60 days if the client is in a hospital; or

(B) 30 days if the client is in any other type of institution; and

(2) for a Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) client for 60 days if the client is in any type of institution.

(d) Bedhold charges. The facility must charge the client or the client's representative for bedhold during institutional leave.

(1) Bedhold charges for a CCAD RC client are the bedhold rate established by the Texas Department of Human Services (DHS), plus room and board charges.

(2) Bedhold charges for a CBA AL/RC client are the room and board charges.

(e) Refund of copayment. The facility must not charge the client or the client's representative more than the maximum amount allowed by DHS for bedhold. The facility must refund the client's copayment for the days the client uses institutional leave.

(1) The facility must refund any copayment paid by a CCAD RC client or the client's representative that is in excess of the bedhold amount. If the client's copayment amount is less than the bedhold charge, DHS pays the difference as described in §46.21 of this chapter (relating to Reimbursement).

(2) The facility must refund all copayments paid by a CBA AL/RC client or the client's representative.

(3) The refund must be made according to the procedures in §46.37(c) of this chapter (relating to Copayment and Room and Board).

(f) Billing during institutional leave. The facility must charge the client or the client's representative only the bedhold amount for the date of admission to an institution. The facility must charge the client or the client's representative the full rate for date of return.

(g) Notification of institutional leave. The facility must notify the DHS case manager of any institutional leave as described in §46.45 of this chapter (relating to Required Notifications).

Source Note: The provisions of this §46.49 adopted to be effective September 1, 2003, 28 TexReg 6941