55 Pa. Code § 1181.56

Current through Register Vol. 54, No. 50, December 14, 2024

Section 1181.56 - Limitations on payment for reserved beds

The Department will make payment to a nursing facility for a reserved bed when the recipient is absent from the facility for a continuous 24-hour period because of hospitalization or therapeutic leave. Each reserved bed for therapeutic leave shall be recorded on the facility's daily census record and invoice. If a bed is being reserved for a recipient who has been hospitalized and that bed is being temporarily occupied by another recipient, the occupied bed shall be recorded on the facility's daily census record and the invoice. A reserved bed shall be available for the recipient upon the recipient's return to the facility. The following limits on payment for reserved bed days apply:

(1)Hospitalization. A recipient receiving skilled nursing care, intermediate care or intermediate care for the mentally retarded-except a recipient in a State-operated intermediate care facility for the mentally retarded-is eligible for a maximum 15 consecutive reserved bed days per hospitalization. The Department will pay a facility at a rate of one-third of the facility's current interim per diem rate on file with the Department for a hospital reserved bed day.

(2)Therapeutic leave. Payment for therapeutic leave days is limited as follows:

(i) A recipient receiving skilled nursing care is eligible for a maximum of 15 days per calendar year for therapeutic leave outside the facility if the leave is included in the individual's plan of care and is ordered by the attending physician.

(ii) A recipient receiving intermediate care is eligible for a maximum of 30 days per calendar year of therapeutic leave outside the facility if the leave is included in the individual's plan of care and is ordered by the attending physician.

(iii) A recipient receiving intermediate care for the mentally retarded is eligible for a maximum of 75 days per calendar year for therapeutic leave outside the facility.

(iv) A recipient receiving both skilled and intermediate level of care during the calendar year is eligible for a maximum of 30 days per calendar year for therapeutic leave.

55 Pa. Code § 1181.56

The provisions of this § 1181.56 codified July 24, 1981, effective 7/25/1981, 11 Pa.B. 2610; amended July 2, 1982, effective 7/1/1982, 12 Pa.B. 2070; corrected July 2, 1982, effective 7/1/1982, 12 Pa.B. 2290; amended March 10, 1989, effective immediately and applies retroactively to January 1, 1989, 19 Pa.B. 1005.

The provisions of this § 1181.56 amended under section 443.1(2) and (3) of the Public Welfare Code (62 P. S. § 443.1(2) and (3)).

This section cited in 55 Pa. Code § 1181.52 (relating to payment conditions); 55 Pa. Code § 1181.56a (relating to limitations on payment for reserved beds-statement of policy); 55 Pa. Code § 1181.62 (relating to noncompensable services); and 55 Pa. Code § 6211.62 (relating to computing the minimum occupancy rate).