Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 331 - Vendor Payments › Section VII-33103 - Payment Limitations

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Temporary Absence of the Client. A client's temporary absence from an ICF/ID
				  will not interrupt the monthly vendor payment to the ICF/ID, provided the
				  following conditions are met:
1. the ICF/ID
				  keeps a bed available for the client's return; and
2. the absence is for one of the following
				  reasons:
a. hospitalization, which does not
				  exceed seven days per hospitalization for treatment of an acute condition;
				  or
b.leave of absence. A temporary
				  stay outside the ICF/ID provided for in the client's written individual
				  habilitation plan. A leave of absence will not exceed 60 days per fiscal year
				  (July 1 through June 30) and will not exceed 45 consecutive days in any single
				  occurrence. Certain leaves of absence will be excluded from the annual 60-day
				  limit as long as the leave does not exceed the 45-consecutive day limit and is
				  included in the written individual habilitation plan. These exceptions are as
				  follows:
i. Special Olympics;
ii. roadrunner-sponsored events;
iii. Louisiana planned conferences;
iv. trial discharge leave-14 days per
				  occurrence;
v. official state
				  holidays; and
vi. two days for
				  bereavement of close family members.
(a).
Close Family Members
-parent, step-parent, child, step-child,
				  brother, step-brother, sister, step-sister, spouse, mother-in-law,
				  father-in-law, grand-parent, or grandchild.
NOTE: Elopements and unauthorized absences under the
					 written individual habilitation plan count against allowable leave days.
					 However, Title XIX eligibility is not affected if the absence does not exceed
					 30 consecutive days and if the ICF/ID has not discharged the
					 client.
c. the following leaves of absence will be
				  excluded from both the annual 60-day limit and the 45-consecutive day limit as
				  long as the leave of absence is included in the written individual habilitation
				  plan:
3. the period of
				  absence shall be determined by counting the first day of absence as the day on
				  which the first 24-hour period of absence expires;
4. a period of 24 continuous hours or more
				  shall be considered an absence. Likewise, a temporary leave of absence for
				  hospitalization or a home visit is broken only if the client returns to the
				  ICF/ID for 24 hours or longer;
5.
				  upon admission, a client must remain in the ICF/ID at least 24 continuous hours
				  in order for the ICF/ID to submit a payment claim for a day of service or
				  reserve a bed;
EXAMPLE: A client admitted to an ICF/ID in the morning and
					 transferred to the hospital that afternoon would not be eligible for any vendor
					 payment for ICF/ID services.
6. if a client transfers from one facility to
				  another, the unused leave days for the fiscal year also transfer. No additional
				  leave days are allocated as a result of a transfer;
7. the ICF/ID shall promptly notify DHH of
				  absences beyond the applicable forty-five- or seven-day limitations. Payment to
				  the ICF/MR shall be terminated from the forty-sixth or eighth day, depending
				  upon the leave of absence. Payment will commence after the individual has been
				  determined eligible for Title XIX benefits and has remained in the ICF/ID for
				  30 consecutive days;
8. the limit
				  on Title XIX payment for leave days does not mean that further leave days are
				  prohibited when provided for in the individual habilitation plan. After the
				  Title XIX payment limit is met, further leave days may be arranged between the
				  ICF/ID and the client, family or responsible party. Such arrangements may
				  include the following options.
a. The ICF/ID
				  may charge the client, family or responsible party an amount not to exceed the
				  Title XIX daily rate.
b. The ICF/ID
				  may charge the client, family or responsible party a portion of the Title XIX
				  daily rate.
c. The ICF/ID may
				  absorb the cost into its operation costs.