Section 405 IAC 5-20-2 - Reserving beds in psychiatric hospitals and psychiatric residential treatment facilitiesAuthority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 2.
(a) Medicaid reimbursement is available for reserving beds in a psychiatric hospital (and not in a general acute care hospital) for hospitalization of members at one-half (1/2) the regular per diem rate when all of the following conditions are present: (1) Hospitalization is ordered by the physician for treatment of an acute condition that cannot be treated in the facility.(2) The total length of time allowed for payment of a reserved bed for a single hospital stay is fifteen (15) days. If the member requires hospitalization longer than the fifteen (15) consecutive days, the member must be discharged from the facility.(3) A physician's order for the hospitalization must be maintained in the member's file at the facility.(b) Medicaid reimbursement is available for reserving beds in a PRTF for hospitalization of members under twenty-one (21) years of age at one-half (1/2) the regular per diem rate subject to all of the following conditions: (1) Hospitalization is ordered by the physician for treatment of an acute condition that cannot be treated in the PRTF.(2) The total length of time allowed for payment of a reserved bed for a single hospital stay is four (4) days. If the member requires hospitalization longer than the four (4) consecutive days, the member must be discharged from the PRTF.(3) A physician's order for the hospitalization must be maintained in the member's file at the PRTF.(4) In no instance will Medicaid reimburse a PRTF for reserving beds for Medicaid members when the facility has an occupancy rate of less than ninety percent (90%).(c) Medicaid reimbursement is available for reserving beds in a psychiatric hospital, but not in a general care hospital, for the therapeutic leaves of absence of members at one-half (1/2) the regular per diem rate when all of the following conditions are present: (1) A leave of absence must be for therapeutic reasons as prescribed by the attending physician and as indicated in the member's habilitation plan.(2) In a psychiatric hospital, the total length of time allotted for therapeutic leaves in any calendar year shall be sixty (60) days per member. If the member is absent from the psychiatric hospital for more than sixty (60) days per year, no further Medicaid reimbursement shall be available for reserving a bed for that member in that year.(3) A physician's order for therapeutic leave must be maintained in the member's file at the facility.(d) Medicaid reimbursement is available for reserving beds in a PRTF for therapeutic leaves of absence of members under twenty-one (21) years of age at one-half (1/2) the regular per diem rate when all of the following conditions are present: (1) A leave of absence must be for therapeutic reasons as prescribed by the attending physician and as indicated in the member's habilitation plan.(2) A physician's order for therapeutic leave must be maintained in the member's file at the facility.(3) In a PRTF, the total length of time allotted for therapeutic leaves in any calendar year shall be fourteen (14) days per member. If the member is absent from the PRTF for more than fourteen (14) days per year, no further Medicaid reimbursement shall be available for reserving a bed for therapeutic leave for that member in that year.(4) In no instance will Medicaid reimburse a PRTF for reserving beds for members when the facility has an occupancy rate of less than ninety percent (90%).Office ofthe Secretary of Family and Social Services; 405 IAC 5-20-2; filed Jul 25, 1997, 4:00p.m.: 20 IR 3333; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Mar 22, 2004, 3:15 p.m.: 27 IR 2476; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAErrata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA