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62 TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE thirty-day count begins with the first day of hospitalization. If payments are suspended because recipient remains hospitalized more than seven (7) days and the thirty-day count expires, a new thirty-day count starts with readmission to the LTC facility. In other words DMMA will not pay seven (7) days out of every thirty (30) days for people who remain in the hospital for weeks at a time. 19 DE Reg. 1092 (06/01/16) 20650.2 Temporary Absence from a Long-Term Care Facility for Reasons Other Than Hospitalization 20650.2.1 A recipient may be absent from a long-term care facility for reasons other than hospitalization for a period of eighteen (18) days per year without interruption of payment to the long-term care facility, as long as such absences are provided for in the recipient's plan of care. 20650.2.2 If a recipient's physical condition is being negatively impacted by his or her emotional need to be in a family setting, prior approval may be obtained for a waiver of the eighteen-day leave of absence limitation (for other than acute care hospitalization) from the Title XIX Medical Consultant in order to allow the patient more time to visit with his or her family. To obtain approval, a written request must be submitted by the long-term care facility to the Long-Term Care Coordinator and must include: 20650.2.2.1 Reason for the request; 20650.2.2.2 Medical summary; 20650.2.2.3 Statement from the LTC facility's medical director regarding the medical necessity of the patient being absent from the LTC facility in excess of eighteen (18) days per year; 20650.2.2.4 Anticipated frequency of absence; and 20650.2.2.5 Number of days the recipient was absent from the LTC facility during the previous six-month period. If the approval is given, the eighteen-day restriction will be waived for six (6) months from the date of approval. Any request for a waiver after the six-month limit must be resubmitted and approved for payments to be continued. 19 DE Reg. 1092 (06/01/16) 20660 Interim Changes Interim changes are any changes in circumstances which could result in a change in eligibility (i.e. discharge, income increases or decreases, death). Interim changes must be evaluated at the time they occur or at the time they are reported to determine the effect on eligibility. Unreported changes could cause loss of Medicaid and/or overpayment. Interim changes which do not affect eligibility may affect monthly patient pay amounts (i.e. health insurance premium change, increases or decreases in income, COLA). Unreported changes may also affect payment to providers such as nursing facilities, hospitals, doctors, etc. 20660.1 Interim Changes Procedures If the nursing facility recipient's income changes anytime during the year, perform the following: update the eligibility system, and notify the recipient/representative and facility. 20660.2 Termination of Medicaid Vendor Payments If a Medicaid nursing facility recipient becomes ineligible due to a change in income or resources and remains in the facility, give 30 days notice of termination to the recipient and the facility. For example, a Medicaid nursing facility resident is determined ineligible on May 10. DSS must give 30 days notice (i.e. June 10). 20660.3 Interim Changes Due to Transfer If a Medicaid nursing facility recipient is transferred to another facility, the following steps are required: 1. compute the pro-rated patient pay amount for each facility 2. update DCIS 3. notify recipient's representative and the facility. 20660.4 Interim Changes Due to Discharge When a Medicaid recipient leaves the nursing facility and is discharged by the facility, the following steps must be taken: 1. complete budget to determine pro-rated patient pay amount 2. update DCIS. The case would be closed effective the last day of discharge month if the client received 10 days notice. Vendor payment would stop the day prior to discharge. 3. notify the recipient's representative and facility. 20660.5 Interim Changes Due to Death When a Medicaid nursing facility recipient expires the following steps must be taken: 1. complete budget to determine pro-rated patient pay amount 2. update DCIS. The case would be closed effective the date of death; vendor payment would stop the day prior to death.