Short stays

Revised date
Purpose statement

To define and clarify a short stay.

What is a short stay?

  • A short stay is when a client enters a medical facility or elects institutional Hospice services for under 30 days and the client is active on an Apple Health program.
  • Financial workers usually learn about short stays after they have ended and the clients have returned to their regular living situation.

Who does the short stay?

  • For clients that are not on services with HCS or DDA, the nursing facility short stay letter is done by whatever agency has the active Medicaid program. The overview chart indicates what agency is responsible for the eligibility of the different medical programs.
    • CSD does the short stay letters for active CN and MN classic Medicaid programs maintained by CSD
    • HCA does the short stay letters for active CN and MN cases maintained by HCA
    • WASHCAP short stay letters are done as a courtesy by the HCS financial worker

How long can a short stay be?

Up to 29 days for:

  • Clients who meet institutional criteria (L-track and K-track).
  • Clients who are eligible for noninstitutional Medicaid under CN, MN, ABP or MCS

When is it appropriate to enter a short stay?

Short stay data can only be entered for:

  • Active medical recipients.
  • After the short stay has ended.
  • In a historical month.
  • Stays in a medical institution or for hospice services.
  • Clients who return to their original setting when the short stay ends.
  • NFLOC authorization has been received by an HCS social worker.

Example: Client resides in an Adult Family Home (AFH) and is admitted to a nursing home for two weeks. The client returns back to the same AFH. This situation should be coded on the Institutional Care page as a short stay.

Example: Client resides at home and is active on an S02 AU. Client admits to a nursing home for three weeks. The client returns home. This situation should be coded on Institutional Care page as a short stay.

Example: Client resides in a nursing facility, and has a medical condition requiring hospitalization. The client discharges from the nursing facility and enters the hospital. After two weeks, the client enters a new nursing facility. This situation should be coded on the Institutional Care page as a change in facilities for the hospital and new nursing facility because the client entered a different nursing facility.

Example: Client resides in an assisted living facility (ALF), and has a medical condition that requires a stay in a nursing facility or hospital for over 29 consecutive days. Client then returns to the same ALF. This situation should be coded on the Institutional Care page as a change in facilities for the nursing facility and new start of services in the ALF.

Example: If a DDA or HCS client in an ALF admits to a nursing facility and had elected hospice, be aware that the bed hold procedure is still applicable. When a bed hold for medical leave is selected the financial worker will take no action until the bed hold expires. The maximum length of stay is 20 days. Set a tickler for 30 days from the date of admission and follow the procedure for hospice in a NF. 

Clarifying Information

Here are some new guidelines on how to code short stays: When HCS/DDA receive notice that a client has admitted to a nursing facility (NF), Residential Habilitation Center (RHC), Hospice Care Center  (HCC) or hospital, we need to wait 30 days before coding the change, so we can determine if it is a short stay or not (even if a 14-443 or 15-345 reports that the stay is likely to exceed 30 days).

  1. If the stay is less than 30 days and an ALF client admits to a NF or hospital, then discharges to a different setting or (ALF) provider, code the changes on the Institutional Care page as a change in facilities and HCB Services. Short stay coding shouldn't be used.
  2. If the stay is less than 30 days and an ALF client admits to a NF or hospital, then goes back to the same setting, code the changes on the Institutional Care page as a short stay.
  3. If the stay is less than 30 days and NF client admits to a hospital, then discharges to a different setting or different NF, code the changes on the Institutional Care page as a facilities change. Short stay coding shouldn't be used.

Review the change letters and look at the Eligibility Results page and the Institutional Care page under Short Stays to review how the cost of care is split between providers and be sure the information is conveyed on the award letters.

What if the short stay spans multiple months?

  • When a short stay spans multiple months, the stay must be entered in the month in which the stay begins.
  • The short stay data doesn't have to be reentered in the following months, but the eligibility must be manually recalculated (using the Calculate Eligibility link on the Eligibility page) in order to determine participation for each month impacted by the stay. 

How is participation assigned to a short stay provider?

  • ACES calculates client cost-of-care responsibility based on data entered on the STAY screen and the clients circumstances.
  • Participation is only assigned to short stays with a Payment Authorization Date entry.
  • Participation is assigned first to the initial provider coded on the Institutional Care page and if there is any remaining participation, it is assigned to the short stay providers.

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