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Therapeutic Leave Days

Page posted: 07/01/02

Page reviewed: 3/15/11

Page updated: 4/3/14

Legal Authority

Minn. R. 9505.0415, subp. 1 through 7

Definitions

Leave day: Any 24-hour period ending at midnight during which a 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.

Reserved bed: Same bed a recipient occupied before leaving the facility for therapeutic leave or an appropriately certified bed if the recipient’s physical condition upon return to the ICF/DD prohibits access to the bed occupied before the recipient left.

Therapeutic leave: Absence of a recipient from an ICF/DD for a non-medical purpose with the expectation the recipient will return to the facility.

Eligibility

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

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

  • • Recipient is absent from the ICF/DD to participate in active programming of the ICF/DD under the personal direction and observation of facility staff, regardless of the number of hours the recipient is absent
  • • ICFs/DD with 25 or more licensed beds do not receive payment for therapeutic leave days in a month for which the average occupancy rate of licensed beds is 96% or less
  • • ICFs/DD with 24 or fewer licensed beds do not receive payment for therapeutic leave days if a licensed bed has been vacant for 60 consecutive days prior to the first leave day of a therapeutic leave
  • Absence for a no-medical purpose includes:

  • • Camp which meets the applicable licensure requirements of the MN Department of Health
  • • Home/family visit
  • • Residential setting other than ICF/DD, hospital or other entity eligible to receive federal, state or county funds to maintain the recipient
  • • Vacation
  • Duration

    Therapeutic leave day payment is limited to 72 days per calendar year.

    Therapeutic Leave Extension Guidelines and Form

    Upon request and approval from DHS, therapeutic leave days may be extended to a maximum of 120 days if requested before their occurrence. DHS may approve up to 48 additional therapeutic leave days per calendar year for family activities if all of the following are met:

  • • Compliance with all applicable federal and state laws
  • • Determined consistent with the Individual Service Plan goals by the county case manager
  • • Requested by the recipient/legal representative and case manager prior to use
  • Submit the Application for Extended Therapeutic Leave Days DHS-4677E (PDF) form to DHS.

    Documentation

    Document the date and the time the recipient leaves an ICF/DD and the date and time the recipient returns to the facility in the recipient’s health record.

    Billing

    Submit claims electronically using MN-ITS. If you submit paper claims, use the UB-92 claim form. MHCP Provider Manual Billing Policy.

    Provider Call Center (651) 431-2700 or (800) 366-5411

    Funding

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

    Audit Recovery

    DHS audits therapeutic 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:

  • • Review timely facility appeals within 15 days of their receipt
  • • Notify a facility of the outcome of the appeal and any instructions necessary, in another 15 days
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