MEDICAID BED HOLD POLICIES BY STATE (September 2012)
MEDICAID BED HOLD POLICIES BY STATE (September 2012)STATEHOSPITAL TRANSFERTHERAPEUTIC LEAVEAMOUNT PAID BYMEDICAIDALABAMAMedicaid residents may not be charged forreservation of a bed for the first four days.http://www.medicaid.state.al.us/ADMIN Code/5-A10-AdmCode.Ch10 LTC 6-18-08.pdfProspective per diem basedon cost and facility class.ALASKALeave of absence due to hospitalization is notcovered.ARIZONABed hold days for recipients admitted to a hospitalfor a short stay are limited to 12 days per contractyear. Members under 21 years of age may use anycombination of bed hold days and therapeutic leavedays per contract year with a limit of 21 days edicalPolicyManual/Chap100.pdfPayments to nursing facilities may be made for therapeutic leavevisits to home, relatives, and friends for up to six days per calendarquarter. A therapeutic leave visit may not exceed three days pervisit. Visits may not be combined to exceed the three-day limit.http://www.medicaid.state.al.us/ADMIN Code/5-A-10AdmCode.Ch10 LTC 6-18-08.pdfThe Division of Health Care Services will not pay for: More than 12 consecutive days of leave of absencewithout written prior authorization. More than 12 total days of absence within a 12-monthperiod per recipient without written prior authorization.Authorized leaves include visits with relatives and friends of notmore than 12 days in duration, and leave to participate intherapeutic or rehabilitative programs. The purpose and plan of alltherapeutic or rehabilitative leave must be documented in therecipient’s plan of care at the facility. Therapeutic or rehabilitativeprograms include, but are not limited to: a) trial visits to alternativecare settings to determine if permanent placement is feasible; b)gradual increased length of visits to prepare recipients for returningto their home or community; and c) extended absences toparticipate in workshop evaluation for rehabilitative ders/BillingManual LongTermCare.pdfTherapeutic leave days are limited to nine days per contract year.Members under 21 years of age may use any combination of bedhold days and therapeutic leave days per contract year with a limitof 21 days per calPolicyManual/Chap100.pdfDays are paid at the sameper diem rate as the dayswhen the recipient is in thefacility.Prospective per diem basedon resident acuity. Paymentshall be denied for anyabsence that is not properlyauthorized, is for purposesother than those listed, or isin excess of the specifiedtime limits.1
ARKANSASThe Medicaid bed hold policy depends on theoccupancy rate of the nursing home. If it is 85%occupied or more, Medicaid will pay for up to 5consecutive days for a leave of absence to thehospital.http://www.daas.ar.gov/pdf/ar nursinghome consumer-guide.pdfMedicaid residents may not be charged forreservation of a bed for the first seven days.Medi-Cal Provider Manual Part 2- Long Term CareMedicaid will pay for up to 14 consecutive days for therapeutichome visits, regardless of the home’s occupancy rate.http://www.daas.ar.gov/pdf/ar nursing-home consumer-guide.pdfProspective cost based perdiem.Eighteen days per calendar year for non-developmentallydisabled recipients. Up to 12 additional days of leave peryear may be approved in increments of no more than twoconsecutive days when the following conditions are met: therequest for additional days of leave shall be in accordancewith the individual recipient care plan and appropriate to thephysical and mental well-being of the patient. At least fivedays of LTC inpatient care must be provided between eachapproved LOA.Medi-Cal Provider Manual Part 2- Long Term CareCOLORADONursing facility medical leave days are not a ColoradoMedical Assistance Program benefit.Source: Colorado Medical Assistance ProgramNursing Facility Billing Manual www.colorado.govCONNECTICUTA nursing home shall reserve, for at least fifteen days,the bed of a resident who is a recipient of medicalassistance and who is absent from such home due tohospitalization unless the nursing home documentsthat it has objective information from the hospitalconfirming that the patient will not return to thenursing home within fifteen days of the hospitaladmission including the day of hospitalization.Non-medical leave days are leave days from the nursing facility fornon-medical reasons, e.g., visits to the homes of family or friends orabsences for therapeutic and/or rehabilitative reasons. Theattending physician must approve the leave and certify that theleave is not contrary to the patient's plan of care. The ColoradoMedical Assistance Program pays for a total of 42 non-medical leavedays per calendar year. With physician approval, clients may payfor room reservations in excess of the combined total 42 nonmedical leave days per calendar year.Source: Colorado Medical Assistance Program Nursing Facility BillingManual www.colorado.govA facility shall be reimbursed for reserving the bed of a residentwho is absent for up to twenty-one days of home leave asauthorized under the Medicaid program if on the day of such anabsence the facility documents that it has a vacancy rate of notmore than four beds or four per cent of licensed capacity,whichever is greater. No facility shall require or request a residentwho is a recipient of medical assistance to provide payment forsuch authorized home leave days, whether or not such payment isavailable from the department.The rate reduction forbed hold or leave ofabsence for acutehospitalization is 6.28 per diem fordates of service onand after August of%20Absence.pdfProspective per diem basedon cost, acuity adjusted,with limits.CALIFORNIAState pays the per diemMedicaid rate to the facility.2
A facility shall be reimbursed for reserving the bed ofa resident who is hospitalized for a maximum ofseven days including the admission date ofhospitalization, if on such date the nursing homedocuments that (A) it has a vacancy rate of not morethan three beds or three per cent of licensedcapacity, whichever is greater, and (B) it contactedthe hospital and the hospital failed to provideobjective information confirming that the personwould be unable to return to the nursing homewithin fifteen days of the date of /connecticut/ctlaws/connecticut statutes 19a-537The nursing home shall be reimbursed for amaximum of eight additional days provided:(A) On the seventh day of the person's hospitalstay, the nursing home has a vacancy rate that is notmore than three beds or three per cent of licensedcapacity, whichever is greater; andDELAWARE(B) Within seven days of the hospitalization of aresident who is a recipient of medical assistance, thenursing home has contacted the hospital for anupdate on the person's status and the nursing homedocuments such contact in the person's file and thatthe information obtained through the contact doesnot indicate that the person will be unable to returnto the nursing home within fifteen days te/connecticut/ct-laws/connecticut statutes 19a-537If a recipient is hospitalized for a short period of timeand is expected to return to the facility, Medicaidreimbursement is available for no more than seven(7) days within any 30-day period. The 30-day countbegins with the first day of hospitalization. Ifpayments are suspended because recipient remainshospitalized more than seven (7) days and the 30count expires, a new 30 day count starts withreadmission to the nursing uals/long.term.care.provider.specific.pdfA recipient may be absent from the nursing facility for reasonsother than hospitalization for a period of 18 days per year withoutinterruption of payment to the nursing facility, as long as suchabsences are provided for in the recipient's plan of /long.term.care.provider.specific.pdfProspective per diem basedon cost and acuity, up toMedicare limits.3
DISTRICT OFCOLUMBIAIf a recipient is hospitalized for a or takes a therapeutic leave, Medicaid reimbursement is available for 18 bed hold days perfiscal year, starting October 1 and ending September 30 of each year.FLORIDAMedicaid pays to reserve a bed for a maximum ofeight days for each hospital stay. One day is definedas an overnight stay away from the nursing facility.Medicaid will pay up to eight days for all medicallynecessary hospitalizations. Each admission to thehospital, even on the same day, begins a newhospital stay. Medicaid will not pay when a residentdoes not plan to return to the nursing facility. Thenursing facility must direct the hospital or resident tosend notification when the resident decides not toreturn. If the decision not to return to the nursingfacility is made while the resident is in the hospitalbut prior to the end of the eight-day allowableperiod, Medicaid will pay to reserve the bed until thenursing facility is advised by the hospital or residentthat the resident will not return to the nursingfacility. Nursing facilities must reserve the bed foreight days unless there is written notification that theresident will not return to the facility.Florida Medicaid Nursing Facility Services Coverageand Limitations HandbookWhen a recipient in a nursing facility or ICF/MR whois authorized for regular vendor payment ishospitalized, the facility's state payment rate (seeSection 1006) may be continued for seven (7) daysduring the hospital stay.http://www.gahsc.org/nm/pp/2005/Nursing FacilityManual.pdfGEORGIAMedicaid pays the nursing facility to reserve a resident’s bed inorder for a resident to go to a family-type setting for a maximum of16 days per each state fiscal year (July 1 through June 30).Therapeutic leave means the resident leaves the facility to go to afamily-type setting and not to another nursing facility. One day isdefined as an overnight stay away from the nursing facility.Florida Medicaid Nursing Facility Services Coverage and LimitationsHandbookEffective April 1, 2003, a nursing facility resident may spend up toeight (8) days within a calendar year with a relative or friendwithout a reduction in the amount of Medical Assistance paymentwith the facility’s state payment rate (see Section 1006). Theattending physician must document in the plan of care that suchvisits are therapeutic in nature. A recipient’s total visits cannotexceed a total of eight days in any calendar year.http://www.gahsc.org/nm/pp/2005/Nursing Facility Manual.pdfProspective per diem basedon cost, with efficiencyincentives, up to Medicarelimits.Effective July 1, 2004, thefacility must have at least 95percent of its Medicaidcertified beds filled in orderto bill Medicaid for the bedhold of a resident. If 5percent or more of thefacility’s Medicaid certifiedbeds are available, Medicaiddoes not pay for a bed-hold.The percentage of Medicaidoccupancy is based uponthe nursing facility’soccupancy for the priorquarter of the year asdefined on the previouspage under Prior QuarterDefinition.Effective for dates of serviceon and after July 1, 2004,payments for patient leavedays or for bed hold daysduring a patient’shospitalization will be madeat 75% of the rate paid fordays when a patient isonsite at a facility. Becausepatient leave days and bedhold days are not subject tothe nursing home providerfee, the payment rate forpatient leave days and bedhold days will exclude anycompensation for theprovider fee.4
GUAMHAWAIINone.None.None.A Medicaid recipient’s bed may be reserved during a recipient’stemporary absence from the long-term care facility if: The recipient’s plan of care provides for absences other than forhospitalization and is approved by the recipient’s attendingphysician; Any single episode during which a bed is reserved does notexceed a period of three consecutive /PMChp1211.pdfN/AProspective cost based perdiem (for therapeuticleave).IDAHOBed holds are not reimbursed for r%20Guidelines/LTC.pdfPayment for reserve beddays is the lesser of 75percent of the NF rate orthe customary charge.ILLINOISThe Nursing Home Care Act requires a nursing facilityto hold a bed for a maximum of ten days when aresident is hospitalized. The facility must hold a bed(not necessarily that specific bed) for up to 10 daysduring a hospitalization. On the 11th day there is norequirement to hold a bed but the resident is still aresident and should receive the next available bedwhen they are ready to return even if there is awaiting Effective February 1, 2011, the Indiana HealthCoverage Programs (IHCP) does not reimbursenursing facilities for holding beds for hospital ortherapeutic leave als/chapter14.pdfEffective December 1, 2009, Medicaid no longer paysto reserve a bed in a nursing facility for a person atNF/ICF level of icymanualpages/Manual Documents/Letters/lmletter/8-I67.pdfWhen a Long Term Care patient residing in a NF goes on LOA tohome, the facility may be eligible for a reserve bed payment if thefacility charges private paying patients for reserve bed days.Therapeutic home visits for residents of up to three days per visitand not to exceed a total of 15 days per calendar year so long as thedays are part of a treatment plan ordered by the attendingphysician. Eligibility for reserve bed payment is determined byMedicaid for 0Guidelines/LTC.pdfThere is no requirement under the Nursing Home Care Act to hold abed for ten days during a therapeutic home visit. However theclient is still considered a resident and must be given the nextavailable bed when they are ready to return even if there is awaiting INDIANAIOWAEffective July 1, 2012payment for bed reserve forall residents of nursingfacilities has beendiscontinued.Effective February 1, 2011, the Indiana Health Coverage Programs(IHCP) does not reimburse nursing facilities for holding beds forhospital or therapeutic leave als/chapter14.pdfEffective December 1, 2009, Medicaid no longer pays to reserve abed in a nursing facility for a person at NF/ICF level of icymanualpages/Manual Documents/Letters/lmletter/8-I-67.pdfEffective December 1, 2009,Medicaid no longer pays toreserve a bed in a nursingfacility for a person atNF/ICF level of care.http://www.dhs.state.ia.us/5
KANSASKENTUCKYKMAP (Kansas Medical allows up to ten days perconfinement for reservation of a bed when a NF,NF/MH, or ICF/MR beneficiary leaves the facility andis admitted to an acute care facility when conditionsunder the reserve day regulations are met. To ensureaccurate payment, the NF, NF/MH orICF/MR must bill hospital leave days consecutively,beginning with the date of admission. KMAP allowsup to 21 days per admission for reservation of a bedwhen an NF/MH resident leaves the facility and isadmitted to one of the state mental hospitals, privatepsychiatric hospital, Prairie View Mental HealthCenter, or a psychiatric ward in an acute carehospital. To ensure accurate payment, the NF/MHmust bill psychiatric leave days consecutively,beginning with the date of ntent/Provider%20Manuals/Nursing 09222010 10113.pdfThe department shall cover and reimburse forreserved bed days for a maximum of fourteen (14)days per calendar year due to der%20Relations/PDF/NF%20-%20ICF-MR.pdfIn the event of a nonmedical absence from a NF, the facility mustreport the absence to the local SRS office. The local SRS office doesnot require an MS-2126 form. A maximum of 18 home leave daysfor NFs and 21 days for NF/MHs are allowed per calendar year.Additional days require prior authorization (PA). Refer to Section4300 of the General Special RequirementsManual for PA /Content/Provider%20Manuals/Nursing 09222010 10113.pdfThe department shall cover and reimburse for reserved bed daysfor a maximum of ten (10) days per calendar year for leaves ofabsence other than sis/policymanualpages/Manual Documents/Letters/lmletter/8-I-67.pdfFull prospective per diembased on cost. Paymentshall be available only forthe days during which thereis likelihood that thereserved bed wouldotherwise be required foroccupancy by someresident.Medicaid pays a percentageof the daily per diem, basedon the prior quarter’soccupancy rate for thefacility, for NursingFacilities.Reimbursed at seventy-five(75) percent of a facility'srate if the facility'soccupancy percent isninety-five (95) percent orgreater; and reimbursed atfifty (50) percent of afacility's rate if the facility'soccupancy percent is lessthan ninety-five (95)percent.Medicaid Reserved BedDays Billing Issues6
LOUISANAMAINEMARYLANDFor each Medicaid recipient, nursing facilities shall bereimbursed for up to seven (7) hospital leave ofabsence days and 15 home leave of absence days peryear.LA Nursing Facility Medicaid ManualPayment of bed holds for hospitalization shall begranted up to ten (10) days. If the member’shospitalization exceeds the ten (10) day (midnights)bed hold period, the resident must receive a medicaleligibility assessment prior to continue MaineCarecoverage of nursing facility services. A leave ofabsence may not be used to extend a bed hold duringa hospital tmChapter II: Section 67 Nursing Facility ServicesLeave of absence due to hospitalization stoppedbeing covered by Medicaid July 1, 2012 resulting inmany facilities charging up to 300 a day to hold aFor each Medicaid recipient, nursing facilities shall be reimbursedfor up to seven (7) hospital leave of absence days and 15 homeleave of absence days per year.LA Nursing Facility Medicaid ManualReimbursement for hospitalleave is 75% of theapplicable per diem rate.Reimbursement paid forhome leave of absencedates will be reduced to90% of the applicable perdiem, including the nursingfacility provider fee, forfacilities with occupancyrates less than 90%.Payment may be made to a facility to reserve a bed for a residenton an overnight leave of absence if: The resident's plan of care provides for such an absence; The resident takes no more than a total of thirty-six (36) days inleaves of absence during the twelve (12) month period from July1 through June 30;Effective for dates of serviceon or after March 1, 2009,the reimbursement forhospital leave of absencedays for facilities withoccupancy rates equal to orgreater than 90% shall be90% of the applicable perdiem rate which includesthe nursing facility providerfee.LA Nursing Facility MedicaidManualProspective per diem basedon cost, up to 10/ch101.htmChapter II: Section 67Nursing Facility ServicesA leave of absence may not be used to extend a bed hold during ahospital tm Chapter II:Section 67 Nursing Facility ServicesMedicaid covers bed reservations for recipients who are on a leaveof absence to visit with friends or relatives or to participate in Stateapproved therapeutic or rehabilitative programs for a maximum ofThe Department willreimburse at the interim perdiem rates for the7
specific bed. Prior to July 1, Medicaid reimbursednursing homes 65 a day when a resident was in thehospital for up to 15 days.http://dhmh.dfmc.org/longTe
1 MEDICAID BED HOLD POLICIES BY STATE (September 2012) STATE HOSPITAL TRANSFER THERAPEUTIC LEAVE AMOUNT PAID BY MEDICAID ALABAMA Medicaid residents may not be charged for reservation of a bed for the first four days.
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1 STATE HOSPITAL TRANSFER THERAPEUTIC LEAVE AMOUNT PAID BY MEDICAID ALABAMA Medicaid residents may not be charged for reservation of a bed for the first four days.
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