09/14/12
Summary:
This Policy Memorandum introduces changes regarding state payment for holding a bed while a resident is temporarily absent from a facility. A manual release with PM and WAG revisions will follow.
Effective 07/01/12, these changes in bed reserve policy are made to comply with the Save Medicaid Access and Resources Together Act (SMART Act; PA 097-0689).
Bed Reserve Payment - Discontinued
Payments for bed reserve are discontinued for all residents of skilled nursing facilities (SNF), intermediate care facilities (ICF) and Institutes for Mental Diseases (IMD);
Bed reserve payments are also discontinued for residents of Intermediate Care Facilities for Persons with Developmental Disabilities (ICF/DD) who are 21 years of age and older. Despite this change, the ID/DD Community Care Act requires the ICF/DD>21 to provide a resident seven days notice to terminate the contract if the resident is compelled to leave the facility for physical or mental health reasons.
Bed Reserve Payment - Continued
Payments for bed reserve continue, with no changes, for residents of Intermediate Care Facilities for Persons with Developmental Disabilities (ICF/DD) who are under 21 years of age, as follows:
- Hospitalization
- 100 percent of a facility's Medicaid per diem for days 1-10 per hospitalization;
- 75 percent of a facility's Medicaid per diem for days 11-30 per hospitalization;
- 50 percent of a facility's Medicaid per diem for days 31-45 per hospitalization.
- Therapeutic visits
- 100 percent of a facility's Medicaid per diem for days 1 -10 per State fiscal year (July 1 - June 30);
- 75 percent of a facility's Medicaid per diem for all days after 10. There is no maximum number of covered days.
Payments also continue for residents of Supportive Living Facilities (SLF), as follows:
- Hospitalization and Therapeutic visits
- 100 percent of a facility's Medicaid per diem for up to 30 days per calendar year.
Reporting and other requirements
Bed reserves must still be reported electronically using the MEDI system. If a resident is admitted to the hospital and there is no bed reserve information reported, conflicts between long term care and hospital dates of service may cause the entire month's LTC claim to be rejected.
The Nursing Home Care Act still requires a nursing facility to hold a bed (not necessarily the same specific bed) for a maximum of ten days when a resident is hospitalized. On the 11th day there is no requirement to hold a bed but the person is still considered a resident and entitled to the next available bed when he or she is ready to return, even if there is a waiting list.
There is no requirement under the Nursing Home Care Act to hold a bed for ten days during a therapeutic home visit; however the person is still considered a resident and must be given the next available bed when he or she is ready to return, even if there is a waiting list.
NOTE: HFS does not control facility decisions to charge for bed reserves. Accordingly, nothing in this policy change is meant to preclude a family member or other individual from making a bed reserve payment on behalf of an adult resident of an SNF, ICF or IMD. HFS considers payments to hold a bed akin to payments for additional luxury services beyond what is medically necessary care. As noted above, facilities must comply with any licensure or certification requirements associated with bed reserves.
[signed copy on file]
Michelle R.B. Saddler
Secretary, Illinois Department of Human Services
Julie Hamos
Director, Illinois Department of Healthcare and Family Services
