Current through Register Vol. 42, No. 11, August 30, 2024
(1) A resident
day is incurred when any one of the following conditions have been met:
(a)
Care is rendered to a
resident in the facility. This results when a resident is rendered
services between the census taking hour (12:00 midnight) on two (2) successive
days. The following procedure illustrates the proper method of determining the
number of resident days resulting from care rendered to residents in the
facility, using the midnight census method:
1.
Number of residents in the facility at midnight.
2. Add/subtract residents admitted/discharged
(including deaths) prior to midnight of the following day (Exception - a
resident admitted and discharged on the same day counts as a resident day). The
provider may bill for the date of admission, but not for the day of
discharge.
(b)
When pre-admission payments are received to ensure a bed is kept
open for a particular resident. The rationale for including these
payments lies in the fact that this bed is not available for occupancy by
another resident. Since the facility is receiving payment for a bed which is,
in effect, unavailable to any other resident, it should be included in resident
day totals.
(c) When a resident is
out of the facility, regardless of the reason, and the facility is receiving
payment for the bed, this day is counted in the same manner as pre-admission
payments as stated above. If the facility is not receiving payment for the bed,
it will not be counted as a resident day.
(d) Medicaid payments to ICF/IIDs for
therapeutic visits will be limited to 14 days per calendar month, not to exceed
14 consecutive days at one time.
(2) Minimum records required to be kept at
the facility are:
(a) Midnight census by
resident name at least one time per calendar month. More frequent census taking
is recommended.
(b) Ledger of all
admissions and discharges/deaths.
(c) Complete therapeutic leave
records.
(d) A monthly analysis
sheet which summarizes all admissions and discharges, paid hold bed days, and
therapeutic leave days. (Schedule 6A at the end of this Chapter is the
recommended analysis sheet; however, providers may utilize any form of their
own design which provides the same information.)
(3) In the event that payment for a
pre-admission day is not received and the charges are subsequently written off
as uncollectable, the facility will not count those days as resident days. The
facility must keep a separate ledger to indicate days in this category. The
ledger must indicate the following:
(b) Dates of
pre-admission days charged.
(c)
Dates of pre-admission days written off as uncollectable.
(d) Reason for uncollectability.
Author: Robin Arrington, Associate Director, LTC
Provider/Recipient Services Unit
Statutory Authority: State Plan; Title XIX,
Social Security Act;
42 C.F.R. §§
447.250 - .255, et
seq.