Date: September 17, 2018
To: Long Term Care Facilities - Specialized Mental Health Rehabilitation Facilities (SMHRFs) only
Re: Payment Change for Therapeutic Leaves of Absence
In the Provider Notice dated June 13, 2018, Specialized Mental Health Rehabilitation Facility (SMHRF) providers were notified that pursuant to Public Act 100-0587 (pdf), payment shall be made for therapeutic leaves of absence that have been indicated by an interdisciplinary team as therapeutically beneficial. This payment is limited to holding a bed while the resident is temporarily absent from the facility for a “therapeutic leave” only. This does not include a hospitalization. Payment shall not exceed 20 days per state fiscal year [July 1 – June 30] and shall not exceed 10 days consecutively. Payment shall be at a rate of 75% of the facility’s Medicaid rate as of June 4, 2018, the effective date of P.A. 100-0587.
This notice informs providers licensed under the Specialized Mental Health Rehabilitation Act of 2013 or those provisionally licensed under the Act, of the provisions set forth in Public Act 100-0646 (pdf). Pursuant to P.A. 100-0646, payment for a “therapeutic leave”, shall not exceed 20 days per state fiscal year and shall not exceed 10 days consecutively. Payment shall be at a rate of 75% of the facility’s Medicaid rate as of July 27, 2018, the effective date of P.A. 100-0646.
· For therapeutic leaves of absence with dates of service between June 4, 2018 and July 26, 2018, payment shall be at a rate of 75% of the facility’s Medicaid rate in effect on June 4, 2018.
· For therapeutic leaves of absence with dates of service on and after July 27, 2018, payment shall be at a rate of 75% of the facility’s Medicaid rate in effect on July 27, 2018. (June 30, 2018 rate + 4%)
There are no changes to ‘Revenue Codes’, ‘Occurrence Span Codes and Dates’ or ‘Value Codes’ as described in the Provider Notice dated June 13, 2018.
Programming logic has not yet been completed, but is anticipated to be complete by October 1, 2018.
The Department will host an Audio Conference call to discuss this policy and address any questions from the providers.
Date: Thursday, September 20, 2018
Time: 11:00 a.m.
Phone: (888) 494-4032 toll free
Access Code: 238 185 5916
If you have questions regarding this notice, contact the Bureau of Long Term Care toll free at 844-528-8444.
Teresa T. Hursey