405 IAC 5-20-2 - Reserving beds in psychiatric hospitals and psychiatric residential treatment facilities
Current through March 30, 2022
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 2.
(a) Medicaid
reimbursement is available for reserving beds in a psychiatric hospital (and
not in a general acute care hospital) for hospitalization of members at
one-half (1/2) the regular per diem rate when all of the following conditions
are present:
(1) Hospitalization is ordered
by the physician for treatment of an acute condition that cannot be treated in
the facility.
(2) The total length
of time allowed for payment of a reserved bed for a single hospital stay is
fifteen (15) days. If the member requires hospitalization longer than the
fifteen (15) consecutive days, the member must be discharged from the
facility.
(3) A physician's order
for the hospitalization must be maintained in the member's file at the
facility.
(b) Medicaid
reimbursement is available for reserving beds in a PRTF for hospitalization of
members under twenty-one (21) years of age at one-half (1/2) the regular per
diem rate subject to all of the following conditions:
(1) Hospitalization is ordered by the
physician for treatment of an acute condition that cannot be treated in the
PRTF.
(2) The total length of time
allowed for payment of a reserved bed for a single hospital stay is four (4)
days. If the member requires hospitalization longer than the four (4)
consecutive days, the member must be discharged from the PRTF.
(3) A physician's order for the
hospitalization must be maintained in the member's file at the PRTF.
(4) In no instance will Medicaid reimburse a
PRTF for reserving beds for Medicaid members when the facility has an occupancy
rate of less than ninety percent (90%).
(c) Medicaid reimbursement is available for
reserving beds in a psychiatric hospital, but not in a general care hospital,
for the therapeutic leaves of absence of members at one-half (1/2) the regular
per diem rate when all of the following conditions are present:
(1) A leave of absence must be for
therapeutic reasons as prescribed by the attending physician and as indicated
in the member's habilitation plan.
(2) In a psychiatric hospital, the total
length of time allotted for therapeutic leaves in any calendar year shall be
sixty (60) days per member. If the member is absent from the psychiatric
hospital for more than sixty (60) days per year, no further Medicaid
reimbursement shall be available for reserving a bed for that member in that
year.
(3) A physician's order for
therapeutic leave must be maintained in the member's file at the
facility.
(d) Medicaid
reimbursement is available for reserving beds in a PRTF for therapeutic leaves
of absence of members under twenty-one (21) years of age at one-half (1/2) the
regular per diem rate when all of the following conditions are present:
(1) A leave of absence must be for
therapeutic reasons as prescribed by the attending physician and as indicated
in the member's habilitation plan.
(2) A physician's order for therapeutic leave
must be maintained in the member's file at the facility.
(3) In a PRTF, the total length of time
allotted for therapeutic leaves in any calendar year shall be fourteen (14)
days per member. If the member is absent from the PRTF for more than fourteen
(14) days per year, no further Medicaid reimbursement shall be available for
reserving a bed for therapeutic leave for that member in that year.
(4) In no instance will Medicaid reimburse a
PRTF for reserving beds for members when the facility has an occupancy rate of
less than ninety percent (90%).
Notes
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