Iowa Admin. Code r. 441-85.25 - Reimbursement to psychiatric medical institutions for children
(1)
Computation of inpatient rate for non-state-owned facilities prior to
July 1, 2014, and for state-owned facilities. For services rendered by
non-state-owned facilities on or before June 30, 2014, or by state-owned
facilities, facilities are paid at a per diem rate based on the facility's
actual and allowable cost for the service not to exceed the upper limit as
provided in 441-subrule 79.1(2).
a. Rates for
new facilities are based on historical costs submitted on Form 470-0664 if the
institution is established and has the historical data. If the institution is
newly established, the rate shall be based on a proposed budget submitted on
Form 470-0664. A Form 470-0664 with actual cost data shall be submitted after
at least six months of participation in the program for a new rate
adjustment.
b. After the initial
cost report period, the institution shall submit Form 470-0664 annually within
three months of the close of the facility's fiscal year. Failure to submit the
report within this time shall reduce payment to 75 percent of the current rate.
The reduced rate shall be paid for no longer than three months, after which
time no further payments will be made.
c. For services rendered on or after August
1, 2011, rates paid shall be adjusted to 100 percent of the facility's actual
and allowable average costs per patient day, based on the cost information
submitted pursuant to paragraphs 85.25(1)"a" and
"b," subject to the upper limit provided in 441-subrule
79.1(2) for non-state-owned facilities. Before rate adjustment, providers shall
be paid a prospective interim rate equal to the previous year's retrospectively
calculated unit-of-service rate.
(2)
Inpatient reimbursement for
non-state-owned facilities effective January 1, 2016. Services
rendered by non-state-owned facilities on or after January 1, 2016, are paid on
a fee-for-service basis.
(3)
Reserve bed payments.
a.
Reserve bed day payment for days a resident of a psychiatric medical
institution for children is absent from the facility for hospitalization in an
acute care general hospital is paid in accordance with the following policies:
(1) The intent of the department and the
facility shall be for the resident to return to the facility after the
hospitalization.
(2) Staff from the
psychiatric medical institution shall be available to provide support to the
child and family during the hospitalization.
(3) Payment for reserve bed days shall be
canceled and payment returned if the facility refuses to accept the child back
except when the department and the facility agree that the return would not be
in the child's best interests. If the department and the facility agree that
the return would not be in the child's best interests, payment shall be
canceled effective the day after the joint decision not to return the
child.
(4) Payment will not be
authorized for over ten days per calendar month and will not be authorized for
over ten days for any continuous hospital stay.
b. Reserve bed days for visitation shall be
made for days a resident is absent from a psychiatric medical institution for
children at the time of a nightly census for the purpose of visitation when the
absence is in accordance with the following policies:
(1) The visits are consistent with the
child's case permanency plan and the facility's individual case plan.
(2) The intent of the department and the
facility shall be for the child to return to the facility after the
visitation.
(3) Staff from the
psychiatric medical institution shall be available to provide support to the
child and family during the visit.
(4) Payment for reserve bed days shall be
canceled and payments returned if the facility refuses to accept the child back
except when the department and the facility agree that the return would not be
in the child's best interests. If the department and the facility agree that
the return would not be in the child's best interests, payment shall be
canceled effective the day after the joint decision not to return the
child.
(5) Payment for reserve bed
days shall be canceled effective the day after a decision not to return the
child is made by the court or, in a voluntary placement, by the
parent.
(6) Payment for reserve bed
days shall not exceed 14 consecutive days or 30 days per year, except upon
written approval of the regional administrator. In no case shall payment exceed
60 days per year for visitation or other absences.
c. Reserve bed payment shall be made for days
a resident is absent from a psychiatric medical institution for children at the
time of the nightly census for reasons such as detention, shelter care, or
running away when the absence is in accordance with the following policies:
(1) The intent of the department and the
psychiatric medical institution for children shall be for the child to return
to the facility after the absence.
(2) Payment for reserve bed days shall be
canceled and payments returned if the facility refuses to accept the child back
except when the department and the facility agree that the return would not be
in the child's best interests. If the department and the facility agree that
the return would not be in the child's best interests, payment shall be
canceled effective the day after the joint decision not to return the
child.
(3) Payment for reserve bed
days shall be canceled effective the day after a decision is made not to return
the child by the court or, in a voluntary placement, by the parent.
(4) Payment for reserve bed days shall not
exceed 14 consecutive days or 30 days per year, except upon written approval of
the regional administrator. In no case shall payment exceed 60 days per year
for visitation or other absences.
(5) Reserve bed day payment is not available
until the child has been physically admitted to the psychiatric medical
institution.
(6) The psychiatric
medical institution shall notify the department social worker within 24 hours
after the child is out of the facility for running away or other unplanned
reasons.
(4)
Day treatment rates. Outpatient day treatment services are
paid on a fixed fee basis.
Notes
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