Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-7 - Intermediate Care Facilities for Individuals with Intellectual Disabilities › Section 5123-7-08 - Intermediate care facilities for individuals with intellectual disabilities - bed-hold days

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
This rule establishes requirements and
				procedures for an intermediate care facility for individuals with intellectual
				disabilities (ICFIID) to be reimbursed for reserving a bed for a resident who
				is temporarily absent.
(B)
								Definitions
For the purposes of this rule, the
				following definitions apply:
(1)
									"Admission" occurs when an individual who was not being
			 counted in the census of any Ohio medicaid-certified ICFIID becomes a resident
			 of an ICFIID. An admission may be a new admission or a return admission after a
			 discharge.
(2)
									"Advanced practice registered nurse" has the same
			 meaning as in section
			 4723.01 of the
			 Revised Code.
(3)
									"Bed-hold day" means a day for which a bed is reserved
			 for a resident of an ICFIID through medicaid reimbursement while the resident
			 is temporarily absent from the ICFIID for hospitalization, therapeutic leave,
			 or a visit with friends or relatives. Reimbursement for bed-hold days may be
			 made only if the resident has the intent and ability or may have cause to
			 return to the same ICFIID. A resident on bed-hold day status is not considered
			 discharged because the ICFIID is reimbursed to hold the bed while the resident
			 is on temporary leave.
(4)
									"Business day" means a day of the week, excluding
			 Saturday, Sunday, or a legal holiday as defined in section
			 1.14
			 of the Revised Code.
(5)
									"Discharge" means the full release of a resident from
			 an ICFIID so that he or she is no longer counted in the ICFIID's census.
			 Reasons for discharge include, but are not limited to, the resident's move to
			 another ICFIID, decision to reside in a community-based setting, or death. The
			 day of discharge is not counted as a bed-hold day or an occupied day except
			 when discharge and admission occur on the same day, in which case the day is
			 considered a day of admission and counts as one occupied day.
(6)
									"Home and
			 community-based services" has the same meaning as in section
			 5123.01
			 of the Revised Code.
(7)
									"Hospital" has the same meaning as in rule
			 3701-59-01 of the
			 Administrative Code.
(8)
									 "Hospitalization" means a resident is temporarily
			 absent from an ICFIID for the purpose of receiving services or being treated in
			 a hospital.
(9)
									"Institution for mental disease" has the same meaning
			 as in rule 5160-3-16.4 of the Administrative Code.
(10)
									"Occupied day"
			 means either:
(a)
										A day of admission; or
(b)
										A day during
			 which a medicaid-eligible resident's stay in an ICFIID is eight or more hours.
			 A day begins at twelve a.m. and ends at eleven fifty-nine
			 p.m.
(11)
									"Readmission" occurs when a resident returns to the
			 same ICFIID following use of bed-hold days.
(12)
									"Skilled nursing
			 facility" means a nursing facility certified to participate in the medicare
			 program.
(13)
									"Therapeutic leave" means a resident is temporarily
			 absent from an ICFIID, and is in a residential setting other than a long-term
			 care facility, hospital, or other entity eligible to receive federal, state, or
			 county funds to maintain a resident, for the purpose of receiving a regimen of
			 therapeutic services or visiting a potential new residential
			 setting.