Date: November 20, 2018
To: Long Term Care Facilities - Specialized Mental Health Rehabilitation Facilities (SMHRFs) only
Re: Payment to SMHRFs for Therapeutic Leave of Absence Days
Effective the date of this notice, programming has been completed to allow payment of SMHRF therapeutic leave of absence days.
Public Act 100-0587 (pdf), Specialized Mental Health Rehabilitation Facility (SMHRF) providers, or those provisionally licensed under the Act, are eligible for payment to hold an empty bed during therapeutic leaves of absence. The resident’s interdisciplinary team must document the leave of absence is therapeutically beneficial.
Payment is limited to days a SMHRF holds the bed while the resident is temporarily absent from the facility for a “therapeutic leave” only. This does not include a temporary absence due to a hospitalization. Payment shall not exceed 20 days per State Fiscal Year (SFY) [July 1 - June 30] and shall not exceed 10 days consecutively. Payment will be 75% of the facility’s Medicaid per diem as of June 4, 2018.
· For therapeutic leave of absence days 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 leave of absence days 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%)
· 0182 - Leave of Absence Days, Patient Convenience – Non-payable Legacy BR Code 21.
· 0183 - Leave of Absence Days, Therapeutic - Payable Legacy BR Code 20.
· 0185 – Leave of Absence Days, Hospitalization – Non-payable Legacy BR Code 11.
Occurrence Span Codes and Dates:
· 74 - Non-covered Level of Care/Leave of Absence Dates
· 80 - Covered Days
· 81 – Non-covered Days (LOA days)
The 6/13/2018 Informational Notice instructed providers to either hold impacted claims with a Revenue Code 0183 until programming allowing payment was completed or to submit claims with Revenue Code 0183, then void and rebill that claim when programming was completed.
· Providers should now submit any impacted claims that were held.
The 180-day timely submittal timeframe for affected claims will begin the date of this Notice.
If you have questions regarding this notice, contact the Bureau of Long Term Care toll free at 844-528-8444.
Teresa T. Hursey