(b) The payment for
reserved bed days is subject to the following limits:
(1)
Hospitalization.
(i) A resident receiving nursing facility
services is eligible for a maximum of 15 consecutive reserved bed days per
hospitalization. The Department will pay a nursing facility at a rate of 1/3 of
the nursing facility's current per diem rate on file with the Department for a
hospital reserved bed day if the nursing facility meets the overall occupancy
requirements of subparagraph (ii).
(ii) A nursing facility's overall occupancy
rate shall equal or exceed the following:
(A)
During the rate year 2009-2010, the nursing facility's overall occupancy rate
for the rate quarter in which the hospital reserved bed day occurs must equal
or exceed 75%.
(B) Beginning with
the rate year 2010-2011 and thereafter, the nursing facility's overall
occupancy rate for the rate quarter in which the hospital reserved bed day
occurs must equal or exceed 85%.
(iii) The Department will calculate a nursing
facility's overall occupancy rate for a rate quarter as follows:
(A) The Department will identify the picture
date for the rate quarter as specified in §
1187.96(a)(5)
(relating to price- and rate-setting computations) and the two picture dates
immediately preceding this picture date.
(B) The Department will calculate the nursing
facility's occupancy rate for each of the picture dates identified in clause
(A) by dividing the total number of assessments listed in the facility's CMI
report for that picture date by the number of the facility's certified beds on
file with the Department on the picture date and multiplying the result by
100%. The Department will assign the highest of the three picture date
occupancy rates as the nursing facility's overall occupancy rate for the rate
quarter.
(C) The Department will
only use information contained on a valid CMI report to calculate a nursing
facility's overall occupancy rate. If a nursing facility did not submit a valid
CMI report for a picture date identified in clause (A), the Department will
calculate the nursing facility's overall occupancy rate based upon the valid
CMI reports that are available for the identified picture dates. If no valid
CMI reports are available for the picture dates identified in clause (A), the
nursing facility is not eligible to receive payment for hospital reserve bed
days in the rate quarter.
(D) For
purposes of this subsection, a valid CMI report is a CMI report that meets the
requirements of §
1187.33(a)(5) and
(6) (relating to resident data and picture
date reporting requirements).
(iv) If the resident's hospital stay exceeds
15 consecutive days, the nursing facility shall readmit the resident to the
nursing facility upon the first availability of a bed in the nursing facility
if, at the time of readmission, the resident requires the services provided by
the nursing facility.
(v) If the
resident's hospital stay is less than or equal to 15 consecutive days, the
nursing facility shall readmit the resident to the same bed the resident
occupied before the hospital stay regardless whether the nursing facility is
eligible for payment for hospital reserved beds under subparagraph (b)(1)(i),
if, at the time of readmission, the resident requires the services provided by
the nursing facility.
(vi) Hospital
reserved bed days may not be billed as therapeutic leave days and may not be
billed to the resident if the resident's hospital stay is less than or equal to
15 consecutive days regardless whether the nursing facility is eligible for
payment for hospital reserved beds under subparagraph (b)(1)(i).
