Bed Hold Request Form and Process

Helping Families. Supporting Communities. Empowering Individuals.
Illinois Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.16.071

Bed Hold Request Form and Process
January, 2016

Policy

When a person is absent from a residential setting, the residential provider may be able to secure payment in recognition of ongoing costs during the absence. These costs may include items such as wages for direct care workers, nurses, etc. The payments are referred to as bed hold payments. The purpose of this Information Bulletin is to describe the types of bed hold payments available in the residential settings funded by the Division of Developmental Disabilities (DDD), as well as the procedures for providers to request and receive these payments.

Please note this Bulletin replaces the bed hold language in the CILA User Guide, Cost Center Definitions, and Reimbursement Levels (Revised January, 2002); the June 24, 2002, Memo to the Field regarding IMPORTANT FY03 Billing and Other Program Changes related to Bed Hold; and the April 4, 2003, Memo to the Field regarding new Bed Hold Extension Request form.

Process and Procedures

Bed hold policies are different depending upon the type of residential setting. The following settings may receive bed hold payments:

  1. Children's Group Homes (CGH, Program Code 17D),
  2. Child Care Institutions (CCI, Program Code 19D),
  3. Special Home Placement (SHP, Program Code 41D),
  4. Supported Living Arrangement (SLA, Program Code 42D, 
  5. Community Living Facility (CLF, Program Code 67D),
  6. Home/Individual Placement (HIP, Program Code 68D),
  7. Community Integrated Living Arrangements (CILA, Program Code 60D), and
  8. Intermediate Care Facilities for Persons with Developmental Disabilities (ICFs/DD).

The amount of bed hold days a provider may bill is set in either statute, rule, or Attachment A to the Community Services Agreement. In some instances, prior approval is required. The sections below detail the amount of days for the programs listed above and describe the process for requesting prior approval when needed.

Please see the Bed Hold Extension Request form (IL462-2027).

Bed Hold for CGH, CCI, SHP, SLA, CLF, and HIP

A total of 60 CUMULATIVE Bed Hold days per state fiscal year are allowed for a person served in the following residential programs: Children's Group Home (CGH), 19D - Child Care Institution (CCI), 41D - Special Home Placement (SHP), 42D - Supported Living Arrangement (SLA), 67D - Community Living Facility (CLF), and 68D - Home/Individual Placement (HIP). For example, a person who goes on frequent overnight weekend visits to a family or friend's home can have up to an aggregate total of 60 bed hold days before payments cease.

The division shall consider requests for approval of over 60 cumulative days of bed hold for a person when a completed Bed Hold Extension Request (IL462-2027) is submitted by the CGH, CCI, SHP, SLA, CLF, or HIP residential service provider to the DDD regional staff.

Bed Hold Billing and Payments In CGH, CCI, SHP, SLA, CLF, and HIP:

  1. The division's billing system will automatically pay for up to 60 cumulative days of bed hold within a State fiscal year for a person enrolled in a CGH, CCI, SHP, SLA, CLF, or HIP Residential Program when an appropriate bed hold code is submitted.
  2. When a person is present at the residential setting for part of the day, the service provider should report the person as "present" with a "P" bill code. When a person is absent for the whole day (midnight to midnight) the residential provider should bill the appropriate bed hold bill code for the person. Appropriate bed hold codes for which a service provider can be paid include: F - Family or Friends home visit or vacation, H - Hospitalization, C - Convalescent Care, S - State-Operated Facility or I - Incarceration. Any day reported as A - Absent will generate a zero $0.00 reimbursement for that day for the person.
  3. Payments automatically stop on the 61st cumulative reported bed hold day for these residential programs.
  4. No payment is issued by the division for any program for any day the person is reported as "A" for absent.
  5. Payments for residential services automatically resume when the person returns to residential services and is reported "P" for present by the residential service provider, as long as the person is still authorized for services with the provider.

Bed Hold for CILA Services

A total of 60 consecutive bed hold days are allowed for a person served in the CILA program. For example, a person who is absent from the CILA site for 45 consecutive dates for a hospitalization and convalescent care and also goes on frequent overnight weekend visits to a friend's home can have a cumulative total of more than 60 bed hold days and the CILA provider will still be paid as long as the days are not consecutive.

A CILA provider who serves a person who leaves and returns to CILA services within 60 consecutive dates is automatically paid for CILA services when the appropriate bed hold code is billed. A Bed Hold Extension Request is not necessary or required when the person returns to the CILA.

Appropriate bed hold codes for which a service provider can be paid include: F - Family or Friends home visit or vacation, H - Hospitalization, C - Convalescent Care, S - State Operated Facility or I - Incarceration. Any day reported as A - Absent will generate a zero $0.00 reimbursement for that day for the person.

Bed Hold When a person Requires Temporary Absences

The DDD will consider approval of an additional 30 days of bed hold (total 90 bed hold days) when a person requires a temporary absence AND intends to return to the CILA provider.

When a person's temporary absence from the CILA will go beyond 60 consecutive days the CILA provider may submit a bed hold extension request for up to an additional 30 days of bed hold. The DDD must be aware of and in agreement of the person's need for the extended absence.

When submitting a Bed Hold Extension Request form (IL462-2027) for anyone in CILA services, the CILA provider must provide statements supporting their bed hold claim with:

  1. The reason(s) why this person had to temporarily leave CILA residential services.
  2. The CILA provider's involvement to facilitate this person's return to CILA residential services with the provider.

The Bed Hold Form is completed by the CILA provider as soon as it appears the person will require more than 60 consecutive days of temporary absence. The CILA provider submits the Bed Hold Extension Request form (IL462-2027) to the appropriate ISC agency who in turn forwards the bed hold extension request to the appropriate Regional Staff within the DDD.

When the DDD approves additional bed hold days for an extended temporary absence, the additional bed hold days will be authorized in the billing system.

Bed Hold When a Person Terminates from CILA Services

The division shall consider approval of bed hold for payment for a person who terminates from CILA when the person has to leave the CILA temporarily with the expectation that he or she will return to the CILA services with the CILA provider.

In consideration of payment for CILA services past the person's reported last day present, a CILA provider must be willing and able to serve the person with the intention that the person was going to return to CILA services with the CILA provider. The CILA provider must have been actively involved with the person, their guardian (if applicable) and the ISC agency, SST, Crisis Stabilization provider, State Operated Developmental Center, medical hospital and/or convalescent care center, etc. as applicable in facilitating the person's return to CILA services. The person's inability to return to the CILA provider must not be as the result of action by the CILA provider or the discharge of the person from the CILA provider's services.

When the above conditions are applicable, and the CILA provider seeks payment for any day past the person's last day reported present, the CILA provider completes and submits a Bed Hold Extension Request (IL462-2027) with required attachments at the time a Service Termination Approval Request (STAR) form (IL462-2028) is submitted.

For anyone in CILA services as part of the Bed Hold Extension Request form (IL462-2027) there are two required statements. The CILA provider MUST provide statements supporting their bed hold claim with:

  1. The reason(s) why this person had to leave CILA residential services resulting in this person's termination.
  2. The provider's involvement to facilitate this person's return to CILA residential services with the provider.

Note: A Bed Hold Extension Request submitted without the two (2) required attachments will be denied and the person's last day present in CILA will be their termination date.

When a Bed Hold Extension Request is submitted, there is a question at the bottom of the STAR form asking if a Bed Hold Extension Request is attached. This question should be answered "YES" if a bed hold request is attached to a STAR Termination form.

The person's last day present in CILA will be the last day a CILA provider is paid for CILA services unless a Bed Hold Extension Request is submitted and approved. In other words, bed hold is NOT automatic for any day(s) past the person's last day present.

A Bed Hold request is not granted past the person's last day present when the CILA provider is unable or unwilling to serve the person or refuses to provide CILA services to the person after an extended absence.

Bed Hold can also be limited by the DDD when:

  1. The person or person's guardian, if applicable, is appealing the person's termination initiated by the CILA provider; or,
  2. The person or the person's guardian, if applicable, makes a choice that the person will not return to CILA services with the current CILA service provider; or,
  3. The person's physician stipulates the person is unable to stay at or return to CILA services; or,
  4. The termination is due to the death of the person. A bed hold will not be granted past the person's date of death.

The Bed Hold Form with the STAR form is forwarded by the CILA Provider to the Person Service Coordinator. The ISC Provider in turn forwards to the appropriate Regional Staff within the Division of Developmental Disabilities.

Bed Hold Billing and Payments In CILA

  1. The division's billing system will automatically pay for up to 60 consecutive days of bed hold for a person enrolled in CILA when an appropriate bed hold code is submitted.
  2. When a person is present at the residential setting for part of the day, the service provider should report the person as "present" with a "P" bill code. When a person is absent for the whole day (midnight to midnight) the residential provider should bill the appropriate bed hold bill code for the person. Appropriate bed hold codes for which a service provider can be paid include: F - Family or Friends home visit or vacation, H - Hospitalization, C - Convalescent Care, S - State-Operated Facility or I - Incarceration. Any day reported as A - Absent will generate a zero $0.00 reimbursement for that day for the person.
  3. CILA payments automatically stop on the 61st consecutive reported bed hold day.
  4. No payment is issued by the division for any program for any day the person is reported as "A" for absent.
  5. CILA payments automatically resume when the person returns to CILA services and is reported "P" for present by the CILA service provider, as long as the person continues to be authorized for services with that provider.

Bed Hold (Reserve) for ICF/DD Services

Providers report bed reserves for hospital stays and home visits via Electronic Data Interchange (EDI) component of the Medicaid Management Information System (MMIS). The submitted bed reserve information is directly updated into the Recipient Data Base (RDB), a Long Term Care subsystem of the MMIS, which is used in pricing and adjusting claims.

The Illinois Administrative Code, Title 89, Part 140, Section 140.523, governs bed hold policy for ICFs/DD. The language is quoted below.

Effective July 22, 2013, ICF/MR Facilities (including ICF/DD and SNF/Ped licenses)

  1. All bed reserves must:
    1. be authorized by the interdisciplinary team (IDT); and
    2. be limited to residents who desire to return to the same facility.
  2. There is no minimum occupancy level ICF/MR facilities must meet for receiving bed reserve payments.
  3. In no facility may the number of vacant beds be less than the number of beds identified for residents having an approved bed reserve. The number of vacant beds in the facility must be equal to or greater than the number of residents allowed bed reserve.
  4. For persons who are under 21 years of age, payment may be approved for hospitalization for a period not to exceed 45 consecutive days. The day the resident is transferred to the hospital is the first day of the reserve bed period. Payment for approved bed reserves for hospitalization is a daily rate at:
    1. 100% of a facility's current Medicaid per diem for the first 10 days of an admission to a hospital;
    2. 75% of a facility's current Medicaid per diem for days 11 through 30 of the admission;
    3. 50% of a facility's current Medicaid per diem for days 31 to 45 of the admission.
  5. Payment may be approved for therapeutic visits which have been indicated by the IDT as therapeutically beneficial. There is no limitation on the bed reserve days for such approved therapeutic visits. The day after the resident leaves the facility is the first day of the bed reserve period. Payment for approved bed reserves for therapeutic visits is a daily rate at:
    1. 100% of a facility's current Medicaid per diem for a period not to exceed 10 days per State fiscal year;
    2. 75% of a facility's current Medicaid per diem for a period which exceeds 10 days per State fiscal year.

If you have questions, related to ICF/DD bed reserve please contact HFS' Bureau of Long Term Care at 217-524-7245.

Effective Date

While this procedure has been long standing and is current Department practice, this clarification is effective immediately with the release of this Information Bulletin.