Purchase of Service (POS) Bed Hold Request Form and Process - REVISED

Policy

NOTE: This Information Bulletin (IB) is to be used in conjunction with the Converting Bed Hold to Occupancy Factor IB. The Converting Bed Hold to Occupancy Factor IB is specific to 24 Hour and Host Family CILAs. This IB pertains to all other residential programs identified in the IB.

When an individual is absent from a residential setting, the residential provider may be able to secure payment in recognition of ongoing costs during the absence of the amount they would traditionally receive to support the individual. The payments are referred to as bed hold payments. The purpose of this IB 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 IB 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; the April 4, 2003, Memo to the Field regarding new Bed Hold Extension Request (IL462-2027) form; and Information Bulletin DD.16.071.

This IB is a companion bulletin with DD.16.072 Service Termination Approval Request (STAR) form & Process. Please refer to DD.16.072 when bed hold is part of the person's termination from DDD services.

Definitions

Bed hold Code "A" (Absent) - this code is to be used when the client is out of the building and the reason for the absence doesn't fit any of the other Bed hold Code definitions. Reporting "A" will generate a $0.00 payment for the day.

Bed hold Code "C" (Convalescent Care) - this code is to be used when a client is in a nursing facility for the entire day (midnight to midnight).

Bed hold Code "F" (Family or Friends home visit or vacation) - this code is to be used when a client is out of the facility with family or friends on a home visit for the entire day (midnight to midnight). This code should also be used when the client is on vacation for the entire day (midnight to midnight).

Bed hold Code "H" (Hospitalization) - this code is to be used when a client is in the hospital for the entire day (midnight to midnight).

Bed hold Code "I" (Incarceration) - this code is to be used when a client is confined to jail or imprisonment for the entire day (midnight to midnight).

Bed hold Code "S" (State Operated Facility or Short-Term Stabilization Home) - this code is to be used when a client is in a State Operated Developmental Center or a Short-Term Stabilization Home for the entire day (midnight to midnight).

Entire day - midnight to midnight.

Part of the day - a significant portion of an entire day equaling more than 8 total hours within a 24-hour period.

Termination - submission of Service Termination Approval Request (STAR) form (IL462-2028).

Bed Hold Process and Procedures

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

• Children's Group Homes (CGH, Program Code 17D),
• Child Care Institutions (CCI, Program Code 19D),
• Special Home Placement (SHP, Program Code 41D),
• Supported Living Arrangement (SLA, Program Code 42D),
• Community Living Facility (CLF, Program Code 67D and 67E), and
• Intermediate Care Facilities for Persons with Intellectual and Developmental Disabilities (ICFs/IDD).

The amount of bed hold days a provider may bill is set in statute, rule, or Attachment A to the IMPACT Agreement. Submitting a Service Termination Approval Request (STAR) form without a bed hold request form will result in the provider only being paid up to the last day the individual was reported "P". The sections below detail the amount of bed hold days allowed for the programs listed above and describe the process for requesting prior approval when needed.

The Bed Hold Extension Request (IL462-2027) form is used to request bed hold extensions for Purchase of Service (POS) programs.

The Service Termination Approval Request (STAR) form (IL462-2028) is used to request termination from CILA, POS, and HBS programs.

Bed Hold for Purchase of Services (POS) Programs: CGH, CCI, SHP, SLA, and CLF

A total of 60 CUMULATIVE Bed Hold days per state fiscal year are allowed for an individual served in the following residential programs: 17D - Children's Group Home (CGH), 19D - Child Care Institution (CCI), 41D - Special Home Placement (SHP), 42D - Supported Living Arrangement (SLA), and 67D and 67E - Community Living Facility (CLF).

For example, an individual who goes on frequent overnight weekend visits to a family or friend's home can have up to an aggregate total (cumulative) of 60 bed hold days before payments cease.

The Division shall consider requests for approval over 60 cumulative days of bed hold for an individual when a completed Bed Hold Extension Request (IL462-2027) form and supporting documentation is submitted by the CGH, CCI, SHP, SLA, or CLF residential service provider to the applicable Independent Service Coordination (ISC) agency who will forward the request through Birdseye to DDD region staff.

The 60 CUMULATIVE Bed Hold days per state fiscal year does provide support and funding to allow residents to participate in activities outside their residential services. Extensive absence from the residential setting should result in consideration to seeking alternative services and planning to ensure that an individual's needs are being met.

A resident in a DDD Medicaid Waiver will have defined outcomes identified in their Personal Plan. Implementation strategies describe how the provider will meet the outcomes cited in the Personal Plan. Any additional funding request (Bed Hold) submitted to the Division should be documented in the person's record. Service options should be discussed and documented for periods requiring extensive Bed Hold.

Service Plans are required for some (Non-Waiver) POS participants. Any additional funding request (Bed Hold) submitted to the Division should be documented in the person's record. Service options should be discussed and documented for periods requiring extensive Bed Hold.

The Bed Hold Extension beyond 60 days will be considered based on need. DDD will review Bed Hold Extension requests in a manner which allows for additional days for situations specific to each individual, such as hospitalization, short term convalescing periods, and trial periods associated with waiver provider selection.

Bed Hold Extension Request Process

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

When an individual's temporary absence from the residential setting will go beyond 60 cumulative days, the residential 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 with the person's need for the extended absence prior to the 61st cumulative day of bed hold. When approved, the additional 30 bed hold days will only be authorized in the payment system AFTER the person successfully returns to residential services with the residential provider. The additional 30 bed hold days may not be authorized if the person does not successfully return to residential services with the residential provider.

In certain circumstances, the individual returning to residential services from an extended absence may need to be served in a different residential setting or a different level of residential supports with the residential provider. The residential provider is not required to hold the individual's bed open or to return the person to the same bed or residential site if circumstances warrant a different living arrangement. However, the person must return to the same residential provider and the residential provider must have an available bed or must offer the first available bed to accommodate the person when they are ready to return to residential services.

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

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. There is no option to extend a Bed Hold beyond the 30-day extension (90 days total cumulative bed hold).

POS Bed Hold Policy:

Effective Date

1/1/2022