PAYMENT LIMITATIONS
§ 6210.71. Limitations on payment for reserved bed days.
(a) Hospital leave is a reserve bed day, limited in number, during which a client is temporarily absent from the facility for hospitalization.
(b) For each hospitalization, a recipient receiving intermediate care for individuals with an intellectual disability, except for a recipient in a State operated ICF/ID, is eligible for a maximum 15 consecutive reserve bed days for hospital leave. The Department will pay a facility at the interim per diem rate on file with the Department for a hospital reserve bed day. Subject to this limit, a facility may include hospital reserve bed days in its census as client days, and costs associated with hospital reserve bed days shall be included in the facility’s cost report. A reserve bed will be available for the recipient upon the recipient’s return to the facility.
(c) Therapeutic leave is a reserve bed day, subject to limits, during which the recipient is temporarily absent from the facility due to the need to obtain a component of the recipient’s individual program plan which cannot be provided directly by the facility. Therapeutic leave is included in the recipient’s individual program plan, and the facility is required to monitor and document therapeutic leave. Therapeutic leave is primarily intended to maintain and further enhance relationships between the recipient and his family. Therapeutic leave includes leave for camp or other special programs.
(d) The Department will make payment to a facility for a reserved bed day when the recipient is absent from the facility for a continuous 24-hour period because of therapeutic leave. Each reserved bed day for therapeutic leave shall be recorded on the facility’s daily census record and invoice. A reserved bed shall be available for the recipient upon the recipient’s return to the facility.
(e) A recipient receiving intermediate care for individuals with an intellectual disability is eligible for a maximum of 75 days per calendar year for therapeutic leave outside the facility.
(f) For each continuous 24-hour period the recipient is absent from the facility, the facility shall bill the Department for a therapeutic leave day, under the limitations in this chapter. When the continuous 24-hour period is broken, this will not count as a reserved bed day.
Authority The provisions of this § 6210.71 amended under section 443.1(2) and (3) of the Human Services Code (62 P.S. § 443.1(2) and (3)).
Source The provisions of this § 6210.71 amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (276204) to (276205).
Cross References This section cited in 55 Pa. Code § 6210.75 (relating to noncompensable services).
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