PM 20-08-14-d

Persons only eligible for QMB are not eligible for bed reserve.

  1. (Facility) Enters bed reserve information Revised textusing the LTC EDI system (via MEDI or REV) to show payable and non-payable bed reserve days. This was formerly done using the Bed Reserve Form (Form 2234).
  2. Deleted text(CO) Applies the customer's income during the bed reserve period.
  • For customers receiving Medicare-covered SNF services: 
  1. (CO) Revises the COS 72, Medicare Coinsurance, or COS 65, Full Medicare Coverage, effective the first day of bed reserve so payment may be made New textfor any payable days. The COS will be changed to the COS in effect before the COS 72 or COS 65.

    Text deleted 

  2. (CO) Uses COS 70, Skilled (SNF), or COS 71, Intermediate (ICF), if there has not been any COS other than COS 72 or COS 65.
  3. (CO) Returns the COS back to COS 72 or COS 65 starting the first day after the end of the bed reserve.
  4. Deleted text(FCRC) Revised textAccess Form 2449 via Mobius and revise the form when Medicare-covered SNF services are discontinued.
  5. (Facility) Notifies FCRC using Revised textMEDI or REV if resident does not return to facility by the day after the last day of the bed reserve.

    Deleted text 

  6. (FCRC) Take appropriate action after receiving Revised textdata submitted via MEDI or REV by facility. The action depends on the customer's location after the bed reserve.
  7. (Facility) Notifies FCRC using Revised textMEDI or REV when Medicare-covered SNF services begin and end.
  8. (FCRC) Revised textImmediately authorize payment of coinsurance in the MMIS subsystem if facility advises that a resident is entitled to Medicare-covered SNF services.

    Optional: Authorization may be done by revising Form 2449. 

  9. (FCRC) Revised textComplete discharge action if customer is admitted to different long term care facility.

    Optional: Action may be done by revising Form 2449.

  10. (FCRC) Revised textTo admit customer to new facility, authorize payment in the LTC subsystem.

    Optional: This may also be done by submitting Long Term Care Authorization (Form 2299).

  11. (BLTC) Notifies the Bureau of Medicaid Integrity (BMI) when a facility fails to comply with bed reserve policy.
  12. (BLTC) Conducts post-payment reviews of payable bed reserve days.
  13. (BLTC) Process any payment adjustments as a result of denials or discrepancies from post-payment reviews.