Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Definitions.
For the purpose of this part, the following terms have the
meanings given them.
A. "Certified
bed" means a bed certified under title XIX of the Social Security
Act.
B. "Discharge" or "discharged"
refers to the status of a recipient as defined in part
9549.0051, subpart
7, as published in the State
Register, December 1, 1986, volume 11, number 22.
C. "Hospital leave" means the status of a
recipient who has been transferred from the long-term care facility to an
inpatient hospital for medically necessary health care, with the expectation
the recipient will return to the long-term care facility.
D. "Leave day" means any calendar day during
which the recipient leaves the facility and is absent overnight, and all
subsequent, consecutive calendar days. An overnight absence from the facility
of less than 23 hours does not constitute a leave day. Nevertheless, if the
recipient is absent from the facility to participate in active programming of
the facility under the personal direction and observation of facility staff,
the day shall not be considered a leave day regardless of the number of hours
of the recipient's absence. For purposes of this item, "calendar day" means the
24 hour period ending at midnight.
E. "Reserved bed" means the same bed that a
recipient occupied before leaving the facility for hospital leave or
therapeutic leave or an appropriately certified bed if the recipient's physical
condition upon returning to the facility prohibits access to the bed he or she
occupied before the leave.
F.
"Therapeutic leave" means the absence of a recipient from a long-term care
facility, with the expectation of the recipient's return to the facility, to a
camp meeting applicable licensure requirements of the Minnesota Department of
Health, a residential setting other than a long-term care facility, a hospital,
or other entity eligible to receive federal, state, or county funds to maintain
a recipient. Leave for a home visit or a vacation is a therapeutic
leave.
Subp. 2.
Payment for leave days.
A leave day is eligible for payment under medical assistance,
subject to the limitations of this part. The leave day must be for hospital
leave or therapeutic leave of a recipient who has not been discharged from the
long-term care facility. A reserved bed must be held for a recipient on
hospital leave or therapeutic leave.
Subp. 3.
Hospital leave.
A hospital leave for which a leave day is claimed must comply
with the conditions in items A to C if the leave day is to be eligible for
medical assistance payment.
A. The
recipient must have been transferred from the long-term care facility to a
hospital.
B. The recipient's health
record must document the date the recipient was transferred to the hospital and
the date the recipient returned to the long-term care facility.
C. The leave days must be reported on the
invoice submitted by the long-term care facility.
Subp. 4.
Therapeutic leave.
A therapeutic leave for which a leave day is claimed must
comply with the conditions in items A and B if the leave day is to be eligible
for payment under medical assistance.
A. The recipient's health care record must
document the date and the time the recipient leaves the long-term care facility
and the date and the time of return.
B. The leave days must be reported on the
invoice submitted by the long-term care facility.
Subp. 5.
Payment limitations on number
of leave days for hospital leave.
Payment for leave days for hospital leave is limited to 18
consecutive days for each separate and distinct episode of medically necessary
hospitalization. For the purpose of this part "separate and distinct episode"
means:
A. the occurrence of a health
condition that is an emergency;
B.
the occurrence of a health condition which requires inpatient hospital services
but is not related to a condition which required previous hospitalization and
was not evident at the time of discharge; or
C. the repeat occurrence of a health
condition that is not an emergency but requires inpatient hospitalization at
least two calendar days after the recipient's most recent discharge from a
hospital.
Subp. 6.
Payment limitations on number of leave days for therapeutic leave.
Payment for leave days for therapeutic leave is limited to
the number of days as in items A to D:
A. recipients receiving skilled nursing
facility services as provided in part
9505.0420, subpart
2, 36 leave days per calendar
year;
B. recipients receiving
intermediate care facility services as provided in part
9505.0420, subpart
3, 36 leave days per calendar
year;
C. recipients receiving
intermediate care facility, developmentally disabled services as provided in
part
9505.0420, subpart
4, 72 leave days per calendar
year. In addition to the number of leave days specified in this item, the
commissioner may approve up to 48 additional therapeutic leave days per
calendar year for family activities if:
(1)
the recipient or recipient's legal representative requests additional
therapeutic leave days;
(2) the
case manager recommends that the leave is consistent with the goals of the
recipient's individual service plan as defined in Minnesota Statutes, section
256B.092,
subdivision 1b;
(3) an evaluation
by the case manager shows that home and community-based services and other
alternative services are not feasible; and
(4) all other state and federal requirements
relating to therapeutic leave days are met;
D. recipients residing in a long-term care
facility that has a license to provide services for persons with physical
disabilities as provided in parts
9570.2000 to
9570.3400, 72 leave days per
calendar year.
Subp. 7.
Payment limitation on billing for leave days.
Payment for leave days for hospital leave and therapeutic
leave shall be subject to the limitation as in items A to C. For purposes of
this subpart, a reserved bed is not a vacant bed when determining occupancy
rates and eligibility for payment of a leave day.
A. Long-term care facilities with 25 or more
licensed beds shall not receive payment for leave days in a month for which the
average occupancy rate of licensed beds is 93 percent or less.
B. Long-term care facilities with 24 or fewer
licensed beds shall not receive payment for leave days if a licensed bed has
been vacant for 60 consecutive days prior to the first leave day of a hospital
leave or therapeutic leave.
C. The
long-term care facility charge for a leave day for a recipient must not exceed
the charge for a leave day for a private paying resident. "Private paying
resident" has the meaning given in part
9549.0020, subpart 35.
Statutory Authority: MS s
256B.04
