Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter III - Allowances for Services
Section 144-101-III-107 - Principles of Reimbursement for Psychiatric Residential Treatment Facility Services
Subsection 144-101-III-107-21 - MEDICAL LEAVE AND THERAPEUTIC LEAVE ALLOWANCES

21.1 Principle for Medical Leave. For members requiring physician ordered hospitalization for treatment of an acute condition that cannot be treated in the PRTF, up to four (4) consecutive days. The PRTF must maintain a physician's order for the hospitalization in the member's file. Should a member be hospitalized for longer than four (4) consecutive days, the PRTF must discharge the member. Documentation is subject to retrospective review.

21.2 Principle for Therapeutic Leave. A member's leave of absence from the PRTF must be for therapeutic reasons as directed by the team physician and as indicated in the member's treatment plan. The facility must maintain a physician's order for the therapeutic leave in the member's file. Therapeutic leave days are limited to seven (7) days per admission. Therapeutic leave days do not have to be consecutive. Documentation is subject to retrospective review.

For billing purposes PRTFs are expected to follow the midnight to midnight method when reporting days of leave for members, even if the facility uses a different definition of a day for statistical or other purposes. PRTFs will be reimbursed their routine and fixed costs rate, as stated on their rate letter, for medical leave and therapeutic leave days. Medical leave days will be billed using revenue code: 0185 and therapeutic leave days will be billed using revenue code 0184. Medical and Therapeutic Leave days are cost settled.