Section 17-134d-36 - Administratively necessary days(a) Administratively Necessary Days are inpatient hospital days reimbursed by Medicaid for services to a Title XIX eligible patient and to a patient who will eventually be determined eligible. A patient qualifying for ANDs does not require an acute hospital level-of-care. Instead, the patient requires medical services at the skilled nursing or intermediate level-of-care. The patient is forced to remain in the hospital because the appropriate medical level-of-care placement in the skilled nursing or intermediate care facility is not available.(b) ANDs are covered under the Title XIX program when the following procedures and conditions are met: (1) The Medicaid patient is no longer at the acute care level of service but is at a skilled nursing level-of-care or at an intermediate level-of-care;(2) Discharge to a skilled nursing facility or intermediate care facility level-of-care bed is impossible due to the unavailability of a bed;(3) The patient's timely discharge and placement to the appropriate skilled nursing facility or intermediate care facility is planned and arranged by the hospital. Clear evidence of this active and continuous process is documented in the patient's hospital medical record;(4) The hospital places the patient who is on administratively necessary day one (1) through administratively necessary day seven (7) on the active waiting list at five (5) skilled nursing facilities or intermediate care facilities, whichever is medically appropriate;(5) In cases where additional ANDs are necessary beyond the seventh (7) day the hospital places the patient on the active waiting list of an additional five (5) facilities. The hospital is required to maintain the patient on the active waiting list of a minimum of ten (10) facilities at all times after the seventh (7) administratively necessary day.(A) All contacts made by the hospital to facilities must be clearly documented in the patient's medical record with dates of contact and facility name;(B) After the patient is discharged the name of the facility must be recorded in the patient's medical record.(6) The patient receiving ANDs accepts the first available skilled nursing or intermediate care facility placement in the State of Connecticut that is medically appropriate. (A) The Department will not pay for ANDs when the patient refuses to be placed in the first available facility. Payment ceases on the day of refusal.(B) If the patient refuses the first available placement the hospital sends the following information to the Medical Director for Medicaid, Department of Income Maintenance, 110 Bartholomew Avenue, Hartford, CT 06106: Name and address of person refusing bed
Patient's name and address (if different)
Medicaid Number (if available)
Name of hospital
Date of admission
Date bed available
Name and address of facility with bed
Date bed refused
Reason for refusal
(C) The requirements in the Medical Services Policy, 150.1 F. IX, a., regarding prior authorization requirements for ANDs are repealed.(D) ANDs shall be reviewed by the Department in accordance with Medical Services Policy on utilization review, 150.1 F. I.-V., as it exists now or as it may be amended from time to time.Conn. Agencies Regs. § 17-134d-36
Effective October 1, 1986