Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 134d - Medical Assistance › Orthodontic Services Provided Under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program › Section 17-134d-36 - Administratively necessary days

Current through July 10, 2024
(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.