N.Y. Comp. Codes R. & Regs. tit. 14 § 576.6

Current through Register Vol. 46, No. 45, November 2, 2024

Section 576.6 - Standards pertaining to reserved bed days

(a) The purpose of reserving a bed and making payment for the days for which a bed is reserved is to make provision for the continued availability of services in the same residential treatment facility for residents who are temporarily hospitalized or who are on leave of absence for a therapy day. A bed may be reserved only for a resident who has been residing in the residential treatment facility for at least 15 consecutive days since the resident's current initial admission to the residential treatment facility.

(1) A bed may be reserved for a resident who is temporarily hospitalized for medical or psychiatric care if the following conditions are met:

(i) The resident is admitted to a hospital, other than a residential treatment facility, which is currently licensed or otherwise authorized to operate pursuant to the laws of the jurisdiction in which the hospital is located.

(ii) The resident is expected, on the day of admission to the hospital, to return to the residential treatment facility in no more than 15 calendar days.

(iii) The residential treatment facility notifies the hospital by telephone, and confirms in writing in accordance with procedures prescribed by the Office of Mental Health, that the resident's bed is being reserved and that the hospital must notify the residential treatment facility during the period that the bed is being reserved of any change in the resident's condition which affects the date of discharge.

(a) On or before the morning of the fourth day of hospital care, the hospital shall notify the residential treatment facility of the resident's anticipated discharge date.

(b) If following the 3rd day and before the 16th day of temporary hospitalization, it becomes necessary to adjust the planned discharge date as a result of either a change in the resident's condition or the availability of additional clinical information, the hospital shall immediately advise the residential treatment facility by telephone.

(iv) The bed reservation shall be extended under the following conditions:

(a) For a resident temporarily hospitalized for medical care the bed reservation shall be extended for up to five additional days, if granting such extension will permit the resident to return to the residential treatment facility within 20 days of the date of admission to the hospital.

(b) For a resident temporarily hospitalized for psychiatric care the bed reservation shall be extended for up to 15 additional days, if granting such extension will permit the resident to return to the residential treatment facility within 30 days of the date of admission to the hospital.

(v) Payment for reserved bed days for temporary hospitalization shall be requested as follows:

(a) When reserved bed days do not exceed 15 days for any single hospital stay and the resident returns immediately to the residential treatment facility payment may be requested without prior authorization.

(b) When a bed reservation has been extended in accordance with clause (iv) (a) or (b) of this paragraph, and the resident returns immediately to the residential treatment facility, the residential treatment facility must request prior authorization from the Office of Mental Health to request payment for the actual period the bed was reserved.

(vi) The bed reservation shall be terminated under the following conditions:

(a) If the planned discharge date determined during the first 3 days of hospitalization is more than 15 days from the day of admission to the hospital, the bed reservation shall be terminated.

(b) If the planned discharge date determined following the third day of temporary hospitalization is more than 15 days from the day of admission to the hospital or, more than 20 days for medical care or more than 30 days for psychiatric care for bed reservations extended in accordance with clause (iv)(a) or (b) of this paragraph, the bed reservation shall be terminated.

(c) If the resident is discharged from the hospital and does not return to the residential treatment facility, the bed reservation shall be terminated on the day the resident is discharged from the hospital.

(vii) All of the above provisions in this paragraph are subject to a vacancy rate of no more than 5% or 2 vacant beds, whichever is greater, on the first day of resident's hospitalization from either the residential treatment facility or the distinct unit of the residential treatment facility, to which the resident is expected to return. A distinct unit will require specific admission criteria listed on the residential treatment facility's operating certificate but will not require a separate reimbursement rate for the unit. When computing a vacancy rate, the RTF must disregard beds that have been reserved for other patients.

(2) A bed may be reserved for a resident who is on a leave of absence for a therapy day if the following conditions are met:

(i) The residential treatment facility has written policies and procedures governing leaves of absence for therapy days. Such policies and procedures are subject to the approval of the Office of Mental Health.

(ii) The leave of absence for a therapy day is in conformance with such policies and procedures.

(iii) The leave of absence for a therapy day is provided for in the resident's individual treatment plan.

(iv) The number of days for which a bed is reserved for any individual whether she/he is a resident in one or more residential treatment facility does not exceed 75 days in any 12-month period.

(v) The resident is not admitted to a hospital, other medical facility or another residential treatment facility.

(vi) The resident returns from the leave of absence for a therapy day and is not discharged within 24 hours of return.

(3) A bed may not be reserved as a direct result of a labor dispute occurring within the residential treatment facility.

(b) Certain requirements of this section may be waived by the Office of Mental Health.

(1) A request for a waiver must be submitted to the office and must justify the need for waiver and include such other information or documentation as the Office of Mental Health may require.

(2) The Office of Mental Health may grant a request for waiver of a requirement if it determines that the request is appropriate and reasonable and that the waiver of the request is in the best interests of the resident and the residential treatment facility.

(3) The circumstances in which waiver of a requirement may be requested are as follows:

(i) The requirement that a bed may be reserved only for a resident who has been residing in the residential treatment facility for at least 15 consecutive days (see subdivision (a) of this section).

(ii) The disallowance of a bed reservation for a resident who is discharged while on a leave of absence for a therapy day or within 24 hours of return may be waived if the discharge was not anticipated on the day of departure from the residential treatment facility and at the time of discharge the resident is determined to no longer be in need of residential treatment facility services (see subparagraph (a)(2)(vii) of this section).

(c) Special limits, subject to the approval of the State Commissioner of Social Services, may be established on an individual basis, based on the recommendation of the Office of Mental Health . The circumstances in which the application of special limits may be requested are as follows:

(1) The limit of 20 calendar days for a resident who is temporarily hospitalized for medical care may be extended if such extension is expected to permit the resident to return to the residential treatment facility (see clause [a][1][iv][a ] of this section).

(2) The limit of 30 calendar days for a resident who is temporarily hospitalized for psychiatric care may be extended if such extension is expected to permit the resident to return to the residential treatment facility (see clause [a][1][iv][ b] of this section).

(d) The Commissioner of Mental Health may waive any of the standards pertaining to reserved bed cays in individual cases under special conditions except those standards requiring the approval of the Commissioner of Social Services as provided for in subdivision (c) of this section.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 576.6

Amended New York State Register August 18, 2021/Volume XLIII, Issue 33, eff. 8/4/2021