Therapeutic leave days
Page posted: 7/1/02 | Page reviewed: 3/15/11 | Page updated: 4/17/20 | |
Legal authority | |||
Definitions | Leave day: Any 24-hour period ending at midnight during which a person 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: The same bed a person occupied before leaving the facility for therapeutic leave or an appropriately certified bed if the person’s physical condition upon return to the ICF/DD prohibits access to the bed occupied before the person left. Therapeutic leave: Absence of a person from an ICF/DD for a non-medical purpose with the expectation the person will return to the facility. | ||
Eligibility | A therapeutic leave day is eligible for MA payment subject to the following: Absence for a no-medical purpose includes: | ||
Duration | Therapeutic leave day payment is limited to 72 days per calendar year. | ||
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: Submit the Application for Extended Therapeutic Leave Days, DHS-4677E (PDF) form to DHS. | ||
Documentation | Document the date and the time the person leaves an ICF/DD and the date and time the person returns to the facility in the person’s health record. | ||
Billing | Submit claims electronically using MN-ITS. If you submit paper claims, use the UB-92 claim form. Resources: | ||
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 ICF/DDs 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. AppealsICFs/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: | ||
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