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Minnesota Department of Human Services ICF/DD Manual
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Hospital Leave Days

Page posted: 01/01/06

Page reviewed: 2/24/11

Page updated: 01/01/06

Legal Authority

Minn. R. 9505.0415, subp. 1 through 7

Definitions

Leave day: Any 24-hour period ending at midnight during which the recipient leaves the facility and is absent overnight as well as all subsequent, consecutive calendar days for the same purpose. An overnight absence from the facility of less than 23 hours does not constitute a leave day.

Hospital leave: Status of a recipient transferred from the ICF/DD to an inpatient hospital for medically necessary health care with the expectation the recipient will return to the ICF/DD.

Reserved bed: Same bed a recipient occupied before transferring to the hospital or an appropriately certified bed if the recipient’s physical condition prohibits access to the bed occupied before the recipient left the ICF/DD.

Separate and distinct episode: Any one of the following:

  • • Occurrence of a health condition that is an emergency
  • • Occurrence of a health condition that requires inpatient hospital services but is not related to a condition that required previous hospitalization and was not evident at the time of discharge
  • • 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
  • Eligibility

    A hospital leave day is eligible for MA payment subject to the following:

  • • Bed must be held ‘reserved’ for the recipient on hospital leave
  • • ICF/DD charges for a hospital leave day for the MA recipient cannot exceed the charge for a hospital leave day for a private pay recipient
  • • Recipient cannot have been discharged from the ICF/DD
  • • Recipient is expected to return to the ICF/DD
  • • Two calendar days must elapse between hospitalizations for the same condition
  • A hospital leave day is not eligible for MA payment subject to the following:

  • • ICFs/DD with 25 or more licensed beds will not receive payment if the average occupancy rate of licensed beds was 93% or less during the month of hospital leave
  • • ICFs/DD with 24 or fewer licensed beds will not receive payment if a licensed bed has been vacant for 60 consecutive days before the first hospital leave day
  • Duration

    Hospital leave day payment is limited to 18 consecutive days for each “separate and distinct episode.” There is no yearly limit of days.

    Documentation

    1. Document the date and the time a recipient leaves the ICF/DD and the date and time a recipient returns to the facility in the recipient’s health record.
    2. Report hospital leave days on the occupancy form submitted monthly to DHS ICF/DD Staff. See also Occupancy Report.

    Funding

    Return funds billed and paid for hospital leave day(s) that were not eligible for MA payment to the State of Minnesota within 30 days of the error.

    Billing

    Submit claims electronically using MN-ITS. If you submit paper claims, use the UB-92 claim form. Billing instructions are in the Minnesota Health Care Programs Billing Policy Overview.
    Provider Call Center
    (651) 431-2700 or (800) 366-5411

    Audit Recovery

    DHS audits hospital leave payments made to ICFs for each state fiscal year (FY), July 1 through June 30. After an FY audit is completed, DHS sends an Audit Findings Notification to the facility informing them of their right to appeal the audit findings within 30 calendar days.

    After the 30-day time limit has passed, DHS enters a replacement claim into MMIS that reduces the next payment to the provider by the amount owed to DHS. The payment is reduced effective the next claim submitted by the facility.

    Appeals

    ICFs/DD have 30 days from the date of the Audit Findings Notification to file an ICF/DD Leave Audit Appeal Notice with DHS.

    DHS will:
    1. Review timely facility appeals within 15 days of their receipt.
    2. Notify a facility of the outcome of the appeal and any instructions necessary, in another 15 days.

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    Updated: 6/24/11 11:33 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 6/24/11 11:33 AM