Section 16.03.10.292 - NURSING FACILITY: PAYMENTS FOR PERIODS OF TEMPORARY ABSENCEPayments may be made for reserving beds in long-term care facilities for participants during their temporary absence if the facility charges private paying patients for reserve bed days, subject to the following limitations:
01.Facility Occupancy Limits. Payment for periods of temporary absence from long term care facilities will not be made when the number of unoccupied beds in the facility on the day preceding the period of temporary absence in question is equal to or greater than:a. If licensed beds are less than one hundred (<100) and they have five (5) or more beds unoccupied, leave of absence payments are not allowed.b. If licensed beds are greater than or equal to one hundred (>100), they must have a minimum occupancy rate of ninety-five percent (95%) for leave of absence payments to be allowed.02.Time Limits. Payments for periods of temporary absence from long term care facilities will be made for therapeutic home visits for nursing facility residents of up to three (3) days per visit and not to exceed a total of fifteen (15) days per calendar year so long as the days are part of a treatment plan ordered by the attending physician.03.Limits on Amount of Payments. Payment for reserve bed days will be the lesser of the following:i. Seventy-five percent (75%) of the audited allowable costs of the facility; orii. The rate charged to private paying patients for reserve bed days.04.Payment Procedures. Each long term care facility must submit its claims to the Department in accordance with the procedures established by the Department. The Department will not pay for a claim on behalf of a medical assistance participant unless the information on the claim is consistent with the information in the Department's computer eligibility file.Idaho Admin. Code r. 16.03.10.292