Current through Register Vol. 50, No. 9, September 20, 2024
A.
Temporary Absence of the Client. A client's temporary absence from an ICF/ID
will not interrupt the monthly vendor payment to the ICF/ID, provided the
following conditions are met:
1. the ICF/ID
keeps a bed available for the client's return; and
2. the absence is for one of the following
reasons:
a. hospitalization, which does not
exceed seven days per hospitalization for treatment of an acute condition;
or
b.leave of absence. A temporary
stay outside the ICF/ID provided for in the client's written individual
habilitation plan. A leave of absence will not exceed 60 days per fiscal year
(July 1 through June 30) and will not exceed 45 consecutive days in any single
occurrence. Certain leaves of absence will be excluded from the annual 60-day
limit as long as the leave does not exceed the 45-consecutive day limit and is
included in the written individual habilitation plan. These exceptions are as
follows:
i. Special Olympics;
ii. roadrunner-sponsored events;
iii. Louisiana planned conferences;
iv. trial discharge leave-14 days per
occurrence;
v. official state
holidays; and
vi. two days for
bereavement of close family members.
(a).
Close Family Members-parent, step-parent, child, step-child,
brother, step-brother, sister, step-sister, spouse, mother-in-law,
father-in-law, grand-parent, or grandchild.
NOTE: Elopements and unauthorized absences under the
written individual habilitation plan count against allowable leave days.
However, Title XIX eligibility is not affected if the absence does not exceed
30 consecutive days and if the ICF/ID has not discharged the
client.
c. the following leaves of absence will be
excluded from both the annual 60-day limit and the 45-consecutive day limit as
long as the leave of absence is included in the written individual habilitation
plan:
3. the period of
absence shall be determined by counting the first day of absence as the day on
which the first 24-hour period of absence expires;
4. a period of 24 continuous hours or more
shall be considered an absence. Likewise, a temporary leave of absence for
hospitalization or a home visit is broken only if the client returns to the
ICF/ID for 24 hours or longer;
5.
upon admission, a client must remain in the ICF/ID at least 24 continuous hours
in order for the ICF/ID to submit a payment claim for a day of service or
reserve a bed;
EXAMPLE: A client admitted to an ICF/ID in the morning and
transferred to the hospital that afternoon would not be eligible for any vendor
payment for ICF/ID services.
6. if a client transfers from one facility to
another, the unused leave days for the fiscal year also transfer. No additional
leave days are allocated as a result of a transfer;
7. the ICF/ID shall promptly notify DHH of
absences beyond the applicable forty-five- or seven-day limitations. Payment to
the ICF/MR shall be terminated from the forty-sixth or eighth day, depending
upon the leave of absence. Payment will commence after the individual has been
determined eligible for Title XIX benefits and has remained in the ICF/ID for
30 consecutive days;
8. the limit
on Title XIX payment for leave days does not mean that further leave days are
prohibited when provided for in the individual habilitation plan. After the
Title XIX payment limit is met, further leave days may be arranged between the
ICF/ID and the client, family or responsible party. Such arrangements may
include the following options.
a. The ICF/ID
may charge the client, family or responsible party an amount not to exceed the
Title XIX daily rate.
b. The ICF/ID
may charge the client, family or responsible party a portion of the Title XIX
daily rate.
c. The ICF/ID may
absorb the cost into its operation costs.
B. Temporary Absence of the Client Due to
Evacuations. When local conditions require evacuation of ICF/ID residents, the
following procedures apply.
1. When clients
are evacuated to a family's or friend's home at the ICF/ID's request, the
ICF/MR shall not submit a claim for a day of service or leave day, and the
client's liability shall not be collected.
2. When clients go home at the family's
request or on their own initiative, a leave day shall be charged.
3. When clients are admitted to the hospital
for the purpose of evacuation of the ICF/ID, Medicaid payment shall not be made
for hospital charges.
4.- 5.
Repealed.
C. Payment
Policy in regard to Date of Admission, Discharge, or Death
1. Medicaid (Title XIX) payments shall be
made effective as of the admission date to the ICF/ID. If the client is
medically certified as of that date and if either of the following conditions
is met:
a. the client is eligible for Medicaid
benefits in the ICF/ID (excluding the medically needy); or
b. the client was in a continuous
institutional living arrangement (nursing home, hospital, ICF/ID, or a
combination of these institutional living arrangements) for 30 consecutive
days; the client must also be determined financially eligible for medical
assistance.
2. The
continuous stay requirement is:
a. considered
met if the client dies during the first 30 consecutive days;
b. not interrupted by the client's absence
from the ICF/ID when the absence is for hospitalization or leave of absence
which is part of the written individual habilitation plan.
3. The client's applicable income is applied
toward the ICF/ID fee effective with the date Medicaid payment is to begin.
4. Medicaid payment is not made
for the date of discharge; however, neither the client, the family, nor
responsible party is to be billed for the date of discharge.
5. Medicaid payment is made for the day of
client's death.
NOTE: The ICF/ID shall promptly notify LDH/BHSF of
admissions, death, and/or all discharges.
D. Advance Deposits
1. An ICF/ID shall neither require nor accept
an advance deposit from an individual whose Medicaid (Title XIX) eligibility
has been established.
EXCEPTION: An ICF/ID may require an advance deposit for the
current month only on that part of the total payment which is the client's
liability.
2. If advance
deposits or payments are required from the client, family, or responsible party
upon admission when Medicaid (Title XIX) eligibility has not been established,
such a deposit shall be refunded or credited to the person upon receipt of
vendor payment.
E.
Retroactive Payment. When individuals enter an ICF/ID before their Medicaid
(Title XIX) eligibility has been established payment for ICF/ID services is
made retroactive to the first day of eligibility after admission.
F. Timely Filing for Reimbursements. Vendor
payments cannot be made if more than 12 months have elapsed between the month
of initial services and submittal of a claim for these services. Exceptions for
payments of claims over 12 months old can be made with authorization from
LDH/BHSF only.
G. Refunds to
Clients
1. When the ICF/ID receives vendor
payments, it shall refund any fees for services collected from clients, family
or responsible party by the end of the month in which vendor payment is
received.
2. Advance payments for a
client's liability (applicable income) shall be refunded promptly if he/she
leaves the ICF/ID.
3. The ICF/ID
shall adhere to the following procedures for refunds.
a. The proportionate amount for the remaining
days of the month shall be refunded to the client, family, or the responsible
party no later than 30 days following the date of discharge. If the client has
not yet been certified, the procedures spelled out in
§33103. G.1 above
shall apply.
b. No penalty shall be
charged to the client, family, or responsible party even if the circumstances
surrounding the discharge occurred as follows:
i. without prior notice; or
ii. within the initial month; or
iii. within some other "minimum stay" period
established by the ICF/ID.
c. Proof of refund of the unused portion of
the applicable income shall be furnished to BHSF upon request.
H. ICF/ID Refunds to
the Department
1. Nonparticipating ICF/ID.
Vendor payments made for services performed while an ICF/ID is in a
nonparticipating status with the Medicaid Program shall be refunded to the
department.
2. Participating
ICF/ID. A currently participating Title XIX, ICF/ID shall correct billing or
payment errors by use of appropriate adjustment void or patient liability (PLI)
adjustment forms.
I.
Sitters. An ICF/ID will neither expect nor require a client to have a sitter.
However, the ICF/ID shall permit clients, families, or responsible parties
directly to employ and pay sitters when indicated, subject to the following
limitations.
1. The use of sitters will be
entirely at the client's, family's, or responsible party's discretion. However,
the ICF/ID shall have the right to approve the selection of a sitter. If the
ICF/ID disapproves the selection of the sitter, the ICF/ID will provide written
notification to the client, family, and/or responsible party, and to the
department stating the reasons for disapproval.
2. Payment to sitters is the direct
responsibility of the client, family or responsible party, unless:
a. the hospital's policy requires a
sitter;
b. the attending physician
requires a sitter; or
c. the
individual habilitation plan (IHP) requires a sitter.
NOTE. Psychiatric Hospitals are excluded from this
requirement.
3.
Payment to sitters is the direct responsibility of the ICF/ID facility when:
a. the hospital's policy requires a sitter
and the client is on hospital leave days;
b. the attending physician requires a
sitter;
c. the IHP requires a
sitter.
4. A sitter will
be expected to abide by the ICF/ID's rules, including health standards and
professional ethics.
5. The
presence of a sitter does not absolve the ICF/ID of its full responsibility for
the client's care.
6. The ICF/ID is
not responsible for providing a sitter if one is required while the resident is
on home leave.
J. Tips.
The ICF/ID shall not permit tips for services rendered by its
employees.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254.
