Section 405 IAC 5-13-6 - Reserving bedsAuthority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 6.
(a) Medicaid reimbursement is available for reserving beds in an ICF/IID for members, at one-half (1/2) the regular per diem rate, when one (1) of the following conditions is present:(1) Hospitalization must be ordered by the physician for treatment of an acute condition that cannot be treated in the facility. The total length of time allowed for payment of a reserved bed for a single hospital stay shall be fifteen (15) days. If the member requires hospitalization longer than the fifteen (15) consecutive days, the member must be discharged from the facility. If the member is discharged from the ICF/IID following a hospitalization in excess of fifteen (15) consecutive days, the ICF/IID is still responsible for appropriate discharge planning if the ICF/IID does not intend to provide ongoing services following the hospitalization for those individuals who continue to require ICF/IID level of services. A physician's order for hospitalization must be maintained in the member's file at the facility.(2) A leave of absence must be for therapeutic reasons, as prescribed by the attending provider and as indicated in the member's habilitation plan. The total length of time allotted for therapeutic leaves in any calendar year shall be sixty (60) days per member residing in an ICF/IID. The leave days need not be consecutive. If the member is absent for more than sixty (60) days per year, no further Medicaid reimbursement shall be available for reserving a bed for that member in that year. A physician's order for the therapeutic leave must be maintained in the member's file at the facility.(b) Although prior authorization is not required to reserve a bed, a physician's order for the hospitalization or leave must be maintained in the member's file at the ICF/IID to obtain reimbursement at the reserved rate.(c) If readmission is required, guidelines should be followed as outlined in admission procedures in sections 7 and 8 of this rule.Office ofthe Secretary of Family and Social Services; 405 IAC 5-13-6; filed Jul 25, 1997, 4:00p.m.: 20 IR 3317; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA