Ill. Admin. Code tit. 89 § 140.523

Current through Register Vol. 48, No. 45, November 8, 2024

Section 140.523 - Bed Reserves

a) Effective for dates of service on or after July 1, 2012, no payments for bed reserve days will be made to a facility licensed under the Nursing Home Care Act [ 210 ILCS 45 ] or the Specialized Mental Rehabilitation Act [ 210 ILCS 48 ]. However, beginning June 1, 2015, for purposes of therapeutic home visits for individuals scoring as TBI on the MDS 3.0, payment shall be approved for bed reserve days in facilities that have at least a 90% occupancy level if at least 80% of their residents are Medicaid eligible. Payment shall be at 75% of the facility's current Medicaid per diem rate and shall not exceed 10 days in a calendar month.

b) Effective July 22, 2013, ICF/MR Facilities (including ICF/DD and SNF/Ped licenses)

1) All bed reserves must:

A) be authorized by the interdisciplinary team (IDT); and

B) be limited to residents who desire to return to the same facility.

2) There is no minimum occupancy level ICF/MR facilities must meet for receiving bed reserve payments.

3) In no facility may the number of vacant beds be less than the number of beds identified for residents having an approved bed reserve. The number of vacant beds in the facility must be equal to or greater than the number of residents allowed bed reserve.

4) For persons who are under 21 years of age, payment may be approved for hospitalization for a period not to exceed 45 consecutive days. The day the resident is transferred to the hospital is the first day of the reserve bed period. Payment for approved bed reserves for hospitalization is a daily rate at:

A) 100% of a facility's current Medicaid per diem for the first 10 days of an admission to a hospital;

B) 75% of a facility's current Medicaid per diem for days 11 through 30 of the admission;

C) 50% of a facility's current Medicaid per diem for days 31 to 45 of the admission.

5) Payment may be approved for therapeutic visits which have been indicated by the IDT as therapeutically beneficial. There is no limitation on the bed reserve days for such approved therapeutic visits. The day after the resident leaves the facility is the first day of the bed reserve period. Payment for approved bed reserves for therapeutic visits is a daily rate at:

A) 100% of a facility's current Medicaid per diem for a period not to exceed 10 days per State fiscal year;

B) 75% of a facility's current Medicaid per diem for a period that exceeds 10 days per State fiscal year.

Ill. Admin. Code tit. 89, § 140.523

Amended at 38 Ill. Reg. 859, effective December 23, 2013

Amended at 41 Ill. Reg. 999, effective 1/19/2017